Provider Demographics
NPI:1205117223
Name:LEADEN, LYNN W (MA, CCC-LSP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:W
Last Name:LEADEN
Suffix:
Gender:F
Credentials:MA, CCC-LSP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:LEADEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-LSP
Mailing Address - Street 1:935 FAIRWAY DR
Mailing Address - Street 2:PO BOX 1036
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-2016
Mailing Address - Country:US
Mailing Address - Phone:631-734-2914
Mailing Address - Fax:
Practice Address - Street 1:935 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-2016
Practice Address - Country:US
Practice Address - Phone:631-734-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008356-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist