Provider Demographics
NPI:1497921910
Name:BURNETT, LEIGH LAWRENCE (MCD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:LAWRENCE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 DATA PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1252
Mailing Address - Country:US
Mailing Address - Phone:205-733-9694
Mailing Address - Fax:205-733-9599
Practice Address - Street 1:2116 DATA PARK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1252
Practice Address - Country:US
Practice Address - Phone:205-733-9694
Practice Address - Fax:205-733-9599
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL634A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist