Healthcare Provider Details

I. General information

NPI: 1861556672
Provider Name (Legal Business Name): SHARON LEACH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ALLEN BROOK LN
WILLISTON VT
05495-9209
US

IV. Provider business mailing address

135 ALLEN BROOK LN
WILLISTON VT
05495-9209
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-2332
  • Fax: 802-878-0230
Mailing address:
  • Phone: 802-878-2332
  • Fax: 802-878-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number848
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number848
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: