Provider Demographics
NPI:1215163092
Name:KURTZ, LEIGH ANNE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:KURTZ
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-0985
Mailing Address - Country:US
Mailing Address - Phone:704-793-6928
Mailing Address - Fax:704-786-2723
Practice Address - Street 1:2297 FAIRPORT DR SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-8705
Practice Address - Country:US
Practice Address - Phone:704-793-6928
Practice Address - Fax:704-786-2723
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist