Individual
JENNIFER E LEIBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5491 FAR HILLS AVE, DAYTON, OH 45429-2325
(937) 436-5763
Mailing address
1430 OAK CT STE 100, BEAVERCREEK, OH 45430-1064
(937) 404-1101
(937) 404-1210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50001562
OH
363AM0700X
Medical Physician Assistant
50.001562
OH
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104799
—
OH
Enumeration date
09/22/2010
Last updated
03/05/2026
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