Provider Demographics
NPI:1881366110
Name:LEEDY, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LEEDY
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 1:18466 FM1818
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949
Mailing Address - Country:US
Mailing Address - Phone:936-676-6136
Mailing Address - Fax:
Practice Address - Street 1:504 SOUTH HOME
Practice Address - Street 2:
Practice Address - City:CORRIGAN
Practice Address - State:TX
Practice Address - Zip Code:75939-7594
Practice Address - Country:US
Practice Address - Phone:936-225-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX235Z00000XMedicaid