Provider Demographics
NPI:1578170452
Name:BRUSH, LEAH MOLLY (MS, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MOLLY
Last Name:BRUSH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2938
Mailing Address - Country:US
Mailing Address - Phone:413-454-1006
Mailing Address - Fax:
Practice Address - Street 1:72 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2938
Practice Address - Country:US
Practice Address - Phone:413-454-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02109L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist