Provider Demographics
NPI:1275945867
Name:LEATH, DEANNA
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:LEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 SAINT PETERS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8197
Mailing Address - Country:US
Mailing Address - Phone:803-331-5620
Mailing Address - Fax:803-345-3149
Practice Address - Street 1:955 SAINT PETERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8197
Practice Address - Country:US
Practice Address - Phone:803-331-5620
Practice Address - Fax:803-345-3149
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist