Healthcare Provider Details

I. General information

NPI: 1679437511
Provider Name (Legal Business Name): MICHELLE LECKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MAIN ST
SHREWSBURY MA
01545-6405
US

IV. Provider business mailing address

12 WOODLAND DELL RD
WILBRAHAM MA
01095-1735
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: