Provider Demographics
NPI:1801080874
Name:LEYBA, KAREN APRIL (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:APRIL
Last Name:LEYBA
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:APRIL
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:CRC PRESCHOOL
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443
Mailing Address - Country:US
Mailing Address - Phone:307-864-9227
Mailing Address - Fax:307-864-2296
Practice Address - Street 1:1025 SHOSHONI RD
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443
Practice Address - Country:US
Practice Address - Phone:307-864-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1770688871Medicaid