Provider Demographics
NPI:1639304694
Name:BRYANT, LEAH DEBORAH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:DEBORAH
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 OLD NORCROSS ROAD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:678-377-2833
Mailing Address - Fax:678-377-2882
Practice Address - Street 1:3556 BRIDLE BROOK DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-2381
Practice Address - Country:US
Practice Address - Phone:470-636-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist