Provider Demographics
NPI:1346623311
Name:CLEMENTS, LEANN MARIE (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:MARIE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CEDAR ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3927
Mailing Address - Country:US
Mailing Address - Phone:505-224-7610
Mailing Address - Fax:505-224-7619
Practice Address - Street 1:415 CEDAR ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3927
Practice Address - Country:US
Practice Address - Phone:505-224-7610
Practice Address - Fax:505-224-7619
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5761231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist