Provider Demographics
NPI:1437288875
Name:LUDEMAN FOGLE, LESLIE ANN (LCSW, LMFT, ACSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:LUDEMAN FOGLE
Suffix:
Gender:F
Credentials:LCSW, LMFT, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 KEYSTONE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3000
Mailing Address - Country:US
Mailing Address - Phone:317-844-6823
Mailing Address - Fax:
Practice Address - Street 1:969 KEYSTONE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3000
Practice Address - Country:US
Practice Address - Phone:317-844-6823
Practice Address - Fax:317-844-8265
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001235A1041C0700X
IN35000361A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist