Provider Demographics
NPI:1861413155
Name:SMITH, LEIGH C (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 INTREPID LN
Mailing Address - Street 2:HIGH PEAKS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2545
Mailing Address - Country:US
Mailing Address - Phone:315-492-8319
Mailing Address - Fax:315-492-3758
Practice Address - Street 1:170 INTREPID LN
Practice Address - Street 2:HIGH PEAKS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2545
Practice Address - Country:US
Practice Address - Phone:315-492-8319
Practice Address - Fax:315-492-3758
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-10-29
Deactivation Date:2008-09-03
Deactivation Code:
Reactivation Date:2008-10-29
Provider Licenses
StateLicense IDTaxonomies
NY0014191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist