Healthcare Provider Details

I. General information

NPI: 1053922187
Provider Name (Legal Business Name): RYAN DAVID LEAHY AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S JACKSON ST STE A
FRANKFORT IN
46041-3314
US

IV. Provider business mailing address

1335 S 650 W
DELPHI IN
46923-8922
US

V. Phone/Fax

Practice location:
  • Phone: 765-202-4221
  • Fax:
Mailing address:
  • Phone: 765-202-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: