Provider Demographics
NPI:1902133556
Name:SCHAID, LEIGH G (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:G
Last Name:SCHAID
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:D
Other - Last Name:KAMRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:23002467A
Mailing Address - Street 1:359 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5002
Mailing Address - Country:US
Mailing Address - Phone:317-334-3919
Mailing Address - Fax:
Practice Address - Street 1:359 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5002
Practice Address - Country:US
Practice Address - Phone:317-334-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002467A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133960LMedicaid