Provider Demographics
NPI:1003026881
Name:ROARK, LEIGH SHANNON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:SHANNON
Last Name:ROARK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 J GOODIN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7563
Mailing Address - Country:US
Mailing Address - Phone:606-546-6513
Mailing Address - Fax:606-523-2256
Practice Address - Street 1:2801 US HIGHWAY 25 E
Practice Address - Street 2:SUITE 98
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2069
Practice Address - Country:US
Practice Address - Phone:606-545-2631
Practice Address - Fax:606-523-2256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY140112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist