Healthcare Provider Details

I. General information

NPI: 1518160274
Provider Name (Legal Business Name): JUDITH L. LESHER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580B WESTPORT RD.
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

580B WESTPORT RD.
ELIZABETHTOWN KY
42701
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-6982
  • Fax: 270-769-5121
Mailing address:
  • Phone: 270-765-6982
  • Fax: 270-769-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0789
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: