Provider Demographics
NPI:1609324813
Name:LEYDIG, ZANE
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:LEYDIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEORGIAN PLACE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-444-0620
Mailing Address - Fax:814-444-0640
Practice Address - Street 1:GEORGIAN PLACE
Practice Address - Street 2:SUITE 309
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-444-0620
Practice Address - Fax:814-444-0640
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health