Healthcare Provider Details

I. General information

NPI: 1073454401
Provider Name (Legal Business Name): MRS. AMY MARIE LEITHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-8700
US

IV. Provider business mailing address

3588 E ALAMO ST
SAN TAN VALLEY AZ
85140-4333
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-5954
  • Fax:
Mailing address:
  • Phone: 480-228-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17162
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: