Healthcare Provider Details

I. General information

NPI: 1760998835
Provider Name (Legal Business Name): JENNA M LEISURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 VIRGINIA CT
CINCINNATI OH
45248-3212
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-574-1100
  • Fax: 513-574-5116
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2507180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: