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NPI Code Detail

MEDICARE: JAIDYN R LEECH

MEDICARE: JAIDYN R LEECH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor05032KS

General Provider Information

NPI Number : 1457165912
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIDYN R LEECH
Provider Business Mailing Address
First Line : 710 N BROADWAY ST
Second Line :
City : PITTSBURG
State : KS
Zip : 66762-3922
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 710 N BROADWAY ST
Second Line :
City : PITTSBURG
State : KS
Zip : 66762-3922
Country : US
Telephone Number : 620-232-3228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2025
Last Update Date : 05/21/2025

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