Healthcare Provider Details

I. General information

NPI: 1932036670
Provider Name (Legal Business Name): LEAH BOOM-JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH BOOM CSFA

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD
LIBERTY TOWNSHIP OH
45044-3500
US

IV. Provider business mailing address

7777 YANKEE RD
LIBERTY TOWNSHIP OH
45044-3500
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-9600
  • Fax:
Mailing address:
  • Phone: 513-803-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: