Provider Demographics
NPI:1053722777
Name:LIEBL, LEANNE (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LIEBL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24D CONGRESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3462
Mailing Address - Country:US
Mailing Address - Phone:516-946-1280
Mailing Address - Fax:
Practice Address - Street 1:24D CONGRESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-3462
Practice Address - Country:US
Practice Address - Phone:516-946-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012498235Z00000X
NY025026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist