Provider Demographics
NPI:1619591716
Name:LEAVITT, ELEANOR
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CENTER BARNSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03225-3601
Mailing Address - Country:US
Mailing Address - Phone:603-269-5161
Mailing Address - Fax:
Practice Address - Street 1:91 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CENTER BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03225-3601
Practice Address - Country:US
Practice Address - Phone:603-269-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist