Provider Demographics
NPI:1568679900
Name:LEYDEN, BRENDA KAY
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:LEYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7088 TIPPECANOE RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9147
Mailing Address - Country:US
Mailing Address - Phone:330-702-8716
Mailing Address - Fax:
Practice Address - Street 1:7088 TIPPECANOE RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9147
Practice Address - Country:US
Practice Address - Phone:330-702-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304385Medicaid