Provider Demographics
NPI:1346130960
Name:WIEDMAR, LEIGH ANN (MS CCC SLP CBIS)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:WIEDMAR
Suffix:
Gender:F
Credentials:MS CCC SLP CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-9459
Mailing Address - Country:US
Mailing Address - Phone:502-432-6638
Mailing Address - Fax:
Practice Address - Street 1:11901 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1040
Practice Address - Country:US
Practice Address - Phone:502-245-3774
Practice Address - Fax:502-254-8767
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist