Basic Information
| Provider Information | |||||||||
| NPI: | 1407964406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIMAN | ||||||||
| FirstName: | LORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171101904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177826450 | ||||||||
| FaxNumber: | 7177826408 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 S 2ND ST | ||||||||
| Address2: | SUITE 3F | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172303459 | ||||||||
| FaxNumber: | 7172303460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AT000417L | PA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | AT000417L | 01 | PA | LICENCE | OTHER |