Healthcare Provider Details

I. General information

NPI: 1396454864
Provider Name (Legal Business Name): LEESA MARIE WADDELL PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

IV. Provider business mailing address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

V. Phone/Fax

Practice location:
  • Phone: 740-796-8835
  • Fax:
Mailing address:
  • Phone: 740-796-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.186758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: