Provider Demographics
NPI:1346369832
Name:MCCONNELL, LEISA T (SLP)
Entity Type:Individual
Prefix:
First Name:LEISA
Middle Name:T
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3279
Mailing Address - Country:US
Mailing Address - Phone:308-234-3037
Mailing Address - Fax:308-236-9621
Practice Address - Street 1:211 W 33RD ST
Practice Address - Street 2:STE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3456
Practice Address - Country:US
Practice Address - Phone:308-236-5884
Practice Address - Fax:308-236-9621
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist