Provider Demographics
NPI:1245853845
Name:WORTHINGTON, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WORTHINGTON
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 1:9055 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:COLDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14033-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9055 SUNSET DR
Practice Address - Street 2:
Practice Address - City:COLDEN
Practice Address - State:NY
Practice Address - Zip Code:14033-9610
Practice Address - Country:US
Practice Address - Phone:716-392-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031167235Z00000X
390200000X
OR17339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program