Provider Demographics
NPI:1467058255
Name:LERITZ, MARGARET JEAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:JEAN
Last Name:LERITZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W WATER ST # B
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2025
Mailing Address - Country:US
Mailing Address - Phone:607-742-9924
Mailing Address - Fax:
Practice Address - Street 1:BIG FLATS ELEMENTARY SCHOOL
Practice Address - Street 2:543 MAPLE ST
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814
Practice Address - Country:US
Practice Address - Phone:607-739-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030275235Z00000X
NY14201207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1467058255Medicaid