Provider Demographics
NPI:1992120240
Name:MINICH, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MINICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:T
Other - Last Name:MINICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:37047 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4130
Mailing Address - Country:US
Mailing Address - Phone:440-283-2286
Mailing Address - Fax:
Practice Address - Street 1:37047 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4130
Practice Address - Country:US
Practice Address - Phone:440-283-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst