Provider Demographics
NPI:1215543780
Name:PIKE, LEAH MCKENZIE (MS CF)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MCKENZIE
Last Name:PIKE
Suffix:
Gender:F
Credentials:MS CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 COTTAGE ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6407
Mailing Address - Country:US
Mailing Address - Phone:518-937-8654
Mailing Address - Fax:
Practice Address - Street 1:42 DANA AVE
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-7975
Practice Address - Country:US
Practice Address - Phone:518-937-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant