Provider Demographics
NPI:1710682455
Name:LAFAY, LEEAH ANNE (MHA, RD, LD)
Entity Type:Individual
Prefix:
First Name:LEEAH
Middle Name:ANNE
Last Name:LAFAY
Suffix:
Gender:F
Credentials:MHA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5376
Mailing Address - Country:US
Mailing Address - Phone:513-682-6980
Mailing Address - Fax:513-981-5783
Practice Address - Street 1:3050 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5379
Practice Address - Country:US
Practice Address - Phone:513-682-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered