Individual
MS. STACY MARIE LEICHENTRITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
42 WILD CHERRY DR, CLYDE, NC 28721-7531
(719) 500-9772
Mailing address
42 WILD CHERRY DR, CLYDE, NC 28721-7531
(719) 500-9772
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT0012498
CO
Other
Enumeration date
03/22/2013
Last updated
09/11/2025
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