Provider Demographics
NPI:1174814131
Name:HUDSON, LEEANN (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14151 MONTFORT
Mailing Address - Street 2:300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:US
Mailing Address - Phone:214-801-6869
Mailing Address - Fax:
Practice Address - Street 1:14151 MONTFORT DR
Practice Address - Street 2:300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3098
Practice Address - Country:US
Practice Address - Phone:214-801-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist