Stacy Leidholt, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7946 Issued in MN

Practice address

300 Coon Rapids Blvd NW Ste 200
Coon Rapids, MN 55433-5645

Phone

(763) 767-0854

NPI assigned

Apr 12, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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 Arts

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.

• Rehabcare Group East, LLC

  • Physical Medicine & Rehabilitation Physician
  • Waco, TX
  • NPI 1215806898
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689898371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16870 91ST AVE N APT 218",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553115485",
            "telephone_number": "763-486-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COON RAPIDS BLVD NW STE 200",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335645",
            "telephone_number": "763-767-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEIDHOLT",
        "first_name": "STACY",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "7946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shu-Chun Lee
• Suzanne M Lee, DNP
• Jeffrey Alan Leech II, APRN, CRNA
• Dianne Lefty, M.A CCC SLP
• Almond Dominique Apolonio Legaspi, DDS
• Justin Ryan Leitch, M.D.
• Himalaya E. Lele, M.D.
• Nadine Rene Lemke
• Susan C Lemm, NP
• Brynn McQuet Lemond

• Speech-Language Pathologist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.