Provider Demographics
NPI:1194236158
Name:PROCKO, LEAH MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:PROCKO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CLEARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3352
Mailing Address - Country:US
Mailing Address - Phone:860-729-7506
Mailing Address - Fax:
Practice Address - Street 1:54 CLEARFIELD RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3352
Practice Address - Country:US
Practice Address - Phone:860-729-7506
Practice Address - Fax:860-729-7506
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist