Provider Demographics
NPI:1013574391
Name:SHAFER, LEIGH BETH
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:BETH
Last Name:SHAFER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:BETH
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2560 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2246
Mailing Address - Country:US
Mailing Address - Phone:704-798-0757
Mailing Address - Fax:
Practice Address - Street 1:2560 MILLBROOK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2246
Practice Address - Country:US
Practice Address - Phone:704-798-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist