Provider Demographics
NPI:1043749419
Name:MARCHETTI, LEAH STACY PANOURGIAS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:STACY PANOURGIAS
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:STACY
Other - Last Name:PANOURGIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2221 LIVERNOIS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:248-544-0360
Mailing Address - Fax:
Practice Address - Street 1:2221 LIVERNOIS RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:248-544-0360
Practice Address - Fax:248-544-0360
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist