Provider Demographics
NPI:1114476462
Name:BROWN, LEEANNE (MS-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEEANNE
Middle Name:
Last Name:BROWN
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 1:122 S GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5977
Mailing Address - Country:US
Mailing Address - Phone:704-883-2801
Mailing Address - Fax:
Practice Address - Street 1:122 S GIBBS RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5977
Practice Address - Country:US
Practice Address - Phone:704-883-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist