Traci Reid Leak, MS, CCC,SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP008211 Issued in GA

Practice address

1994 Township Dr
Winder, GA 30680-5633

Phone

(252) 258-6200

NPI assigned

Jun 27, 2013

Last updated

Aug 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Glow Forward Therapy, LLC

  • Speech-Language Pathologist
  • Winder, GA
  • NPI 1861374381
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723248000000",
    "number": "1013357649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 TOWNSHIP DR",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306805633",
            "telephone_number": "252-258-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1994 TOWNSHIP DR",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306805633",
            "telephone_number": "252-258-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAK",
        "first_name": "TRACI",
        "middle_name": "REID",
        "credential": "MS, CCC,SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-27",
        "last_updated": "2024-08-10",
        "certification_date": "2024-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP008211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laboratory South Inc
• Lacey Katelyn Lackey, DPT
• Sierra Larkin
• Michael Latella
• Danielle Lazenby
• Hyun Min Lee, PHARMD
• James Lee
• Legacy Healthcare Services, Inc.
• Miurell Lemus Fuentes
• Anna Leon

• Speech-Language Pathologist in Winder, GA
• Providers in Winder, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.