Provider Demographics
NPI:1871559484
Name:KERN, LESLIE HELEN (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:HELEN
Last Name:KERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W WILSON BRIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2237
Mailing Address - Country:US
Mailing Address - Phone:614-436-6080
Mailing Address - Fax:614-261-6670
Practice Address - Street 1:450 W WILSON BRIDGE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2237
Practice Address - Country:US
Practice Address - Phone:614-436-6080
Practice Address - Fax:614-261-6670
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R71886Medicare UPIN
CP12221Medicare ID - Type Unspecified