Provider Demographics
NPI:1780024869
Name:JERYC, LEAH MARIE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:JERYC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 COACHLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6943
Mailing Address - Country:US
Mailing Address - Phone:405-488-8573
Mailing Address - Fax:
Practice Address - Street 1:12101 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1800
Practice Address - Country:US
Practice Address - Phone:405-226-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist