Provider Demographics
NPI:1235477563
Name:LEAF, BARBARA ANNE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:LEAF
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 1:3440 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3552
Mailing Address - Country:US
Mailing Address - Phone:307-267-7224
Mailing Address - Fax:307-266-2032
Practice Address - Street 1:3440 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3552
Practice Address - Country:US
Practice Address - Phone:307-267-7224
Practice Address - Fax:307-266-2032
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12030386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist