Provider Demographics
NPI:1528643673
Name:EDWARDS, LESLIE MARIE (RDN, LD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-0281
Mailing Address - Country:US
Mailing Address - Phone:520-971-3242
Mailing Address - Fax:
Practice Address - Street 1:791 E MCMILLAN ST STE 103A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1938
Practice Address - Country:US
Practice Address - Phone:513-995-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09365133VN1006X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic