Provider Demographics
NPI:1235709759
Name:JENNIFER A. LEIGH, M.S. CCC-SLP, INC.
Entity Type:Organization
Organization Name:JENNIFER A. LEIGH, M.S. CCC-SLP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-663-9828
Mailing Address - Street 1:7243 US HIGHWAY 301 S STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8399
Mailing Address - Country:US
Mailing Address - Phone:813-663-9828
Mailing Address - Fax:888-965-6670
Practice Address - Street 1:7243 US HIGHWAY 301 S STE A
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8399
Practice Address - Country:US
Practice Address - Phone:813-663-9828
Practice Address - Fax:888-965-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003986900Medicaid