MEDICARE: KARA LEACH MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-2826	ID
2	235Z00000X	Speech-Language Pathologist	15173	NC

General Provider Information

NPI Number	:	1013949262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA LEACH MA

Provider Business Mailing Address
First Line	:	7405 CHOUDER LANE
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587
Country	:	US
Telephone Number	:	425-943-1552
Fax Number	:	919-882-9432

Provider Business Practice Location Address
First Line	:	335 S WHITE ST STE A
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2916
Country	:	US
Telephone Number	:	425-943-1552
Fax Number	:	919-882-9432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/19/2024

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Directions to “ KARA LEACH MA” Practice Location

Language	Start Address	Practice Location

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