Healthcare Provider Details

I. General information

NPI: 1912891086
Provider Name (Legal Business Name): LEAH MICHELLE LONGNECKER MA, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 W DUNKERTON RD
WATERLOO IA
50703-9648
US

IV. Provider business mailing address

4309 WILD HORSE DR
CEDAR FALLS IA
50613-8289
US

V. Phone/Fax

Practice location:
  • Phone: 319-291-2509
  • Fax:
Mailing address:
  • Phone: 319-939-8619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number132518
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: