Provider Demographics
NPI:1790133668
Name:LEITZY, SARAH MICHELE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MICHELE
Last Name:LEITZY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 EATON RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9725
Mailing Address - Country:US
Mailing Address - Phone:419-689-0954
Mailing Address - Fax:
Practice Address - Street 1:2303 OHIO 602
Practice Address - Street 2:
Practice Address - City:NORTH ROBINSON
Practice Address - State:OH
Practice Address - Zip Code:44820-8510
Practice Address - Country:US
Practice Address - Phone:419-562-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist