Individual
IRIS LEYRETANA SUMATRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
900 CLUB DR, WESTERVILLE, OH 43081-4909
(614) 899-2838
(614) 899-2876
Mailing address
900 CLUB DR, WESTERVILLE, OH 43081-4909
(614) 899-2838
(614) 899-2876
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-8112
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094740
—
OH
Enumeration date
01/30/2007
Last updated
11/15/2014
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