Provider Demographics
NPI:1649399841
Name:GEORGE, LEANNA D (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:D
Last Name:GEORGE
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 1:210 TRAVIS BRANCH ROAD
Mailing Address - Street 2:P.O. BOX 1490
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-886-6724
Mailing Address - Fax:606-886-0380
Practice Address - Street 1:210 TRAVIS BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-886-6724
Practice Address - Fax:606-886-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist