Provider Demographics
NPI:1093271215
Name:TOTTEN, LEAH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:TOTTEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 NW OVERTON ST APT 323
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1893
Mailing Address - Country:US
Mailing Address - Phone:310-266-1150
Mailing Address - Fax:
Practice Address - Street 1:1953 NW OVERTON ST APT 323
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1893
Practice Address - Country:US
Practice Address - Phone:310-266-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist