Provider Demographics
NPI:1942426622
Name:HENSLEY-LEIDEKER, PENNY J (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:J
Last Name:HENSLEY-LEIDEKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 E WARNER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3055
Mailing Address - Country:US
Mailing Address - Phone:480-820-6366
Mailing Address - Fax:480-820-0462
Practice Address - Street 1:690 E WARNER RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3055
Practice Address - Country:US
Practice Address - Phone:480-820-6366
Practice Address - Fax:480-820-0462
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist