Provider Demographics
NPI:1437616083
Name:LEGGON, TRISHA RENEE
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:RENEE
Last Name:LEGGON
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 1:203 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3525
Mailing Address - Country:US
Mailing Address - Phone:903-574-3586
Mailing Address - Fax:
Practice Address - Street 1:1009 WAL ST STE 105
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-8172
Practice Address - Country:US
Practice Address - Phone:903-224-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11662237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11662OtherTX HEARING INSTRUMENT FITTER AND DISPENSER