Provider Demographics
NPI:1326566910
Name:SHULTZ, DANA-LEIGH (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DANA-LEIGH
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MILBURY RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-5603
Mailing Address - Country:US
Mailing Address - Phone:484-374-9546
Mailing Address - Fax:
Practice Address - Street 1:694 WHARTON BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1189
Practice Address - Country:US
Practice Address - Phone:610-715-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004396L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist