Individual
LEAH E FONDAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-7121
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1350
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000673315
ANTHEM
KY
Enumeration date
05/04/2010
Last updated
08/17/2023
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