Provider Demographics
NPI:1588854061
Name:BRANT, LEAH ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ANN
Last Name:BRANT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 GREYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605
Mailing Address - Country:US
Mailing Address - Phone:229-242-6670
Mailing Address - Fax:229-242-6671
Practice Address - Street 1:3368 GREYSTONE WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605
Practice Address - Country:US
Practice Address - Phone:229-242-6670
Practice Address - Fax:229-242-6671
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174741037OtherMORE THAN WORDS ORGANIZAT
GA867779344AOtherMORE THAN WORDS MEDICAID
GA797709298BMedicaid
GA797709298AMedicaid
GA797709298AOtherPEACH CARE FOR KIDS ID