Provider Demographics
NPI:1750783536
Name:JUDICE, LEAH (MS, CCC-SLP, HIS)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:JUDICE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SHALLOWCREEK VW
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6618
Mailing Address - Country:US
Mailing Address - Phone:270-210-0090
Mailing Address - Fax:
Practice Address - Street 1:143 LONG RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1223
Practice Address - Country:US
Practice Address - Phone:636-536-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012397235Z00000X
MO2022048117237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist