Healthcare Provider Details

I. General information

NPI: 1780337857
Provider Name (Legal Business Name): KATHLEEN LEEDY LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 23 MILE RD STE 103
SHELBY TOWNSHIP MI
48315-2767
US

IV. Provider business mailing address

13001 23 MILE RD STE 103
SHELBY TOWNSHIP MI
48315-2767
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 800-693-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008087
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362009474
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: