Provider Demographics
NPI:1033466115
Name:THORNSBERRY, LEIGH ANN
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:THORNSBERRY
Suffix:
Gender:F
Credentials:
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 187
Mailing Address - Street 2:
Mailing Address - City:WHEELWRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41669-0187
Mailing Address - Country:US
Mailing Address - Phone:859-358-7891
Mailing Address - Fax:
Practice Address - Street 1:1031 KY ROUTE 306
Practice Address - Street 2:
Practice Address - City:WHEELWRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41669-9031
Practice Address - Country:US
Practice Address - Phone:859-358-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5800235Z00000X
KY165601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty