Healthcare Provider Details

I. General information

NPI: 1316541774
Provider Name (Legal Business Name): HEIDI LIEBENBERG CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MINER ST
WEST CHESTER PA
19382-2149
US

IV. Provider business mailing address

1259 WINTER LN
SCHWENKSVILLE PA
19473-1979
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-3120
  • Fax:
Mailing address:
  • Phone: 484-942-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: