Provider Demographics
NPI:1609595172
Name:LIBERADZKI, LESLEE (SLP)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:LIBERADZKI
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 1:302 E. CLAY STREET
Mailing Address - Street 2:
Mailing Address - City:MT. BLANCHARD
Mailing Address - State:OH
Mailing Address - Zip Code:45867
Mailing Address - Country:US
Mailing Address - Phone:419-889-8554
Mailing Address - Fax:
Practice Address - Street 1:245 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2460
Practice Address - Country:US
Practice Address - Phone:419-562-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20222082-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist