Provider Demographics
NPI:1528405669
Name:SMITH, LEAH MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:SMITH
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 1:1410 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6302
Mailing Address - Country:US
Mailing Address - Phone:972-424-0148
Mailing Address - Fax:972-422-5275
Practice Address - Street 1:1410 E 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6302
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist