Provider Demographics
NPI:1316194681
Name:LEIBENGUTH, PARIS MARIE (MS-CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:PARIS
Middle Name:MARIE
Last Name:LEIBENGUTH
Suffix:
Gender:F
Credentials:MS-CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8722
Mailing Address - Country:US
Mailing Address - Phone:585-704-4143
Mailing Address - Fax:
Practice Address - Street 1:640 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8722
Practice Address - Country:US
Practice Address - Phone:585-704-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011604-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist