Provider Demographics
NPI:1750518262
Name:LEITH, HEATHER RAECHEL (MS ED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAECHEL
Last Name:LEITH
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RAECHEL
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1705
Mailing Address - Country:US
Mailing Address - Phone:716-837-0696
Mailing Address - Fax:
Practice Address - Street 1:603 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4461
Practice Address - Country:US
Practice Address - Phone:716-692-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018110-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist