Provider Demographics
NPI:1427009158
Name:LEIBERHER, CAROLYN (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:LEIBERHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 S 2ND ST
Practice Address - Street 2:SUITE 3F
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1612
Practice Address - Country:US
Practice Address - Phone:717-230-3459
Practice Address - Fax:717-230-3411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006429L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL006429LOtherSTATE LICENSE