Provider Demographics
NPI:1336178797
Name:LEIDY, GORDON A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:A
Last Name:LEIDY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 LUCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2047
Mailing Address - Country:US
Mailing Address - Phone:610-696-6192
Mailing Address - Fax:
Practice Address - Street 1:276 LUCKY HILL RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2047
Practice Address - Country:US
Practice Address - Phone:610-696-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000232L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist