Provider Demographics
NPI:1407550478
Name:SPITZNAGLE, LEA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:SPITZNAGLE
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 1:1965 WINDING HILL RD APT 1314
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1358
Mailing Address - Country:US
Mailing Address - Phone:712-579-9278
Mailing Address - Fax:
Practice Address - Street 1:1804 17TH AVE
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:IL
Practice Address - Zip Code:61486-9200
Practice Address - Country:US
Practice Address - Phone:309-596-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146016865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist