MEDICARE: LEAH BOOM-JACKSON

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
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1932036670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH BOOM-JACKSON

Provider Business Mailing Address
First Line	:	7777 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-803-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-803-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ LEAH BOOM-JACKSON ” Practice Location

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