Provider Demographics
NPI:1235130139
Name:VANDECREEK, LEON D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:D
Last Name:VANDECREEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N EDWIN C MOSES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6837
Mailing Address - Country:US
Mailing Address - Phone:937-775-4334
Mailing Address - Fax:937-775-4323
Practice Address - Street 1:9 N EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6837
Practice Address - Country:US
Practice Address - Phone:937-775-4334
Practice Address - Fax:937-775-4323
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical