Provider Demographics
NPI:1164649364
Name:ROSSI, LEISHA M (MS, CCCSPL)
Entity Type:Individual
Prefix:
First Name:LEISHA
Middle Name:M
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MS, CCCSPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MASON DR
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-8007
Mailing Address - Country:US
Mailing Address - Phone:570-640-0811
Mailing Address - Fax:
Practice Address - Street 1:14 MASON DR
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-8007
Practice Address - Country:US
Practice Address - Phone:570-640-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001460L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist