Healthcare Provider Details

I. General information

NPI: 1861097206
Provider Name (Legal Business Name): ADAM LEYENDECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 04/19/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 MONTGOMERY RD
CINCINNATI OH
45212
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-993-5241
  • Fax: 513-586-2768
Mailing address:
  • Phone: 513-795-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.465251
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: