Provider Demographics
NPI:1497041727
Name:BRALY, LEAH M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:BRALY
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 1:1211 CAMP RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9206
Mailing Address - Country:US
Mailing Address - Phone:843-906-3385
Mailing Address - Fax:
Practice Address - Street 1:1211 CAMP RIDGE LN
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9206
Practice Address - Country:US
Practice Address - Phone:843-906-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist