Provider Demographics
NPI:1508071234
Name:HUTCHISON, LEISA CAROL (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEISA
Middle Name:CAROL
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:LEISA
Other - Middle Name:SMITH
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:125 HUNTSMAN CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7064
Mailing Address - Country:US
Mailing Address - Phone:270-746-9021
Mailing Address - Fax:270-746-0159
Practice Address - Street 1:125 HUNTSMAN CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7064
Practice Address - Country:US
Practice Address - Phone:270-746-9021
Practice Address - Fax:270-746-0159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist