Provider Demographics
NPI:1518530922
Name:PRITZL, LEAH RAE (MS)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:PRITZL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E MORROW DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-2862
Mailing Address - Country:US
Mailing Address - Phone:480-369-7010
Mailing Address - Fax:
Practice Address - Street 1:2750 S CORRAL ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:AZ
Practice Address - Zip Code:86329-0470
Practice Address - Country:US
Practice Address - Phone:480-369-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP13118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist