Provider Demographics
NPI:1194836056
Name:THERAPY ZONE, LLC
Entity Type:Organization
Organization Name:THERAPY ZONE, LLC
Other - Org Name:LESLIE HAMMOND D.B.A. THERAPY ZONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ SPEECH LANG. PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:662-349-2733
Mailing Address - Street 1:7160 TCHULAHOMA
Mailing Address - Street 2:BLD B-SUITE 4
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9266
Mailing Address - Country:US
Mailing Address - Phone:662-349-2733
Mailing Address - Fax:662-536-1849
Practice Address - Street 1:7160 TCHULAHOMA
Practice Address - Street 2:BLD B, SUITE 4
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9266
Practice Address - Country:US
Practice Address - Phone:662-349-2733
Practice Address - Fax:662-536-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7384169OtherAETNA
TN4019252OtherBLUE CROSS/ BLUE SHEILD
052625865OtherBLUE CROSS/ BLUE SHEILD
MS09015269Medicaid