Provider Demographics
NPI:1033886551
Name:DALEY, LEON DWIGHT
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:DWIGHT
Last Name:DALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 SW BEAR PAW TRL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7941
Mailing Address - Country:US
Mailing Address - Phone:386-212-8988
Mailing Address - Fax:
Practice Address - Street 1:2664 SW BEAR PAW TRL
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-7941
Practice Address - Country:US
Practice Address - Phone:386-212-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SA17951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist