Provider Demographics
NPI:1245785542
Name:LEAP, MANDY (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:LEAP
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 BRIGHT MOON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5239
Mailing Address - Country:US
Mailing Address - Phone:937-241-1390
Mailing Address - Fax:
Practice Address - Street 1:1110 CHAPEL HILLS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3923
Practice Address - Country:US
Practice Address - Phone:937-241-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist