Provider Demographics
NPI:1467769158
Name:FARRELL, LEAH ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:ANN
Last Name:FARRELL
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 1:146 MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1843
Mailing Address - Country:US
Mailing Address - Phone:631-589-5885
Mailing Address - Fax:
Practice Address - Street 1:146 MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1843
Practice Address - Country:US
Practice Address - Phone:631-589-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008556-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist