Provider Demographics
NPI:1679700348
Name:NIX, LEILONI N (MS,SLP)
Entity Type:Individual
Prefix:MISS
First Name:LEILONI
Middle Name:N
Last Name:NIX
Suffix:
Gender:F
Credentials:MS,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 LANCASTER FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3727
Mailing Address - Country:US
Mailing Address - Phone:888-230-2022
Mailing Address - Fax:888-483-7046
Practice Address - Street 1:441 LANCASTER FARM RD
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3727
Practice Address - Country:US
Practice Address - Phone:888-230-2022
Practice Address - Fax:888-483-7046
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1679700348Medicaid