| Doctor Name: | STACY LEIDHOLT |
| NPI Number: | 1689898371 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-SLP |
| License Number: | 7946 |
| Business Practice Address: | 300 Coon Rapids Blvd Nw Ste 200 Coon Rapids, MN - 554335645 |
| Business Phone Number: | 7637670854 |
| Business Fax Number: | |
| Mailing Address: | 16870 91st Ave N Apt 218, MAPLE GROVE |
| State: | MN |
| Postal Code: | 553115485 |
| Phone Number: | 7634863584 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7946 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |