Healthcare Provider Details

I. General information

NPI: 1528643673
Provider Name (Legal Business Name): LESLIE MARIE EDWARDS RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 E MCMILLAN ST STE 103A
CINCINNATI OH
45206-1938
US

IV. Provider business mailing address

PO BOX 281
AMELIA OH
45102-0281
US

V. Phone/Fax

Practice location:
  • Phone: 513-995-6790
  • Fax:
Mailing address:
  • Phone: 520-971-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD.09365
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD.09365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: