Provider Demographics
NPI:1568006591
Name:STEWART, LEIGH KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:KATHERINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5824 GOLDEN WEST TRL SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6229
Mailing Address - Country:US
Mailing Address - Phone:678-428-3046
Mailing Address - Fax:
Practice Address - Street 1:5824 GOLDEN WEST TRL SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6229
Practice Address - Country:US
Practice Address - Phone:678-428-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008896235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty