Provider Demographics
NPI:1053922187
Name:LEAHY, RYAN DAVID (AUD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:LEAHY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 S 650 W
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-8922
Mailing Address - Country:US
Mailing Address - Phone:765-202-4221
Mailing Address - Fax:
Practice Address - Street 1:1303 S JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-3314
Practice Address - Country:US
Practice Address - Phone:765-202-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002729A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN23002729AOtherAUDIOLOGIST STATE LICENSE