Provider Demographics
NPI:1629115548
Name:LEEK-BRACCO, CAROLE ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ANN
Last Name:LEEK-BRACCO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 NW 62ND WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2498
Mailing Address - Country:US
Mailing Address - Phone:206-473-7488
Mailing Address - Fax:
Practice Address - Street 1:7824 NW 62ND WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2498
Practice Address - Country:US
Practice Address - Phone:206-473-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013974-1235Z00000X
FLSA15050235Z00000X
WALL00002280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist