Provider Demographics
NPI:1114204583
Name:LEICHER-KRAMER, JILL STACY (CCC/SLP, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:STACY
Last Name:LEICHER-KRAMER
Suffix:
Gender:F
Credentials:CCC/SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 YELLOWSTONE BLVD
Mailing Address - Street 2:APT 4M
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3164
Mailing Address - Country:US
Mailing Address - Phone:718-459-7545
Mailing Address - Fax:
Practice Address - Street 1:7025 YELLOWSTONE BLVD
Practice Address - Street 2:APT 4M
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3164
Practice Address - Country:US
Practice Address - Phone:718-459-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008829-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist