Provider Demographics
NPI:1750671657
Name:LEECE, MEGAN C (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:LEECE
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 1:805 S CROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1714
Mailing Address - Country:US
Mailing Address - Phone:315-443-5761
Mailing Address - Fax:315-443-4413
Practice Address - Street 1:805 S CROUSE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1714
Practice Address - Country:US
Practice Address - Phone:315-443-5761
Practice Address - Fax:315-443-4413
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 012325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0T007OtherBLUECROSS BLUESHIELD