Provider Demographics
NPI:1437792777
Name:LEACH, VIRGINIA E (AUD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:LEACH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:E
Other - Last Name:LAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:750 MID CITIES BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2793
Practice Address - Country:US
Practice Address - Phone:817-347-2955
Practice Address - Fax:817-656-3659
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81206231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist