Provider Demographics
NPI:1285860940
Name:LEISTER, CATHERINE M (MED-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:LEISTER
Suffix:
Gender:F
Credentials:MED-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LEROY GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7461
Mailing Address - Country:US
Mailing Address - Phone:828-452-8070
Mailing Address - Fax:828-452-8072
Practice Address - Street 1:75 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7461
Practice Address - Country:US
Practice Address - Phone:828-452-8070
Practice Address - Fax:828-452-8072
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist