Provider Demographics
NPI:1548810385
Name:ECHOLS-BLAKELY, LESLEY
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:ECHOLS-BLAKELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3739
Mailing Address - Country:US
Mailing Address - Phone:216-533-5423
Mailing Address - Fax:
Practice Address - Street 1:3841 NORTHWOOD RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3739
Practice Address - Country:US
Practice Address - Phone:216-533-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty