Provider Demographics
NPI:1679963052
Name:SCOTT, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SCOTT
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 1:67 GARFIELD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5286
Mailing Address - Country:US
Mailing Address - Phone:619-339-7727
Mailing Address - Fax:
Practice Address - Street 1:5500 S GRANT ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4578
Practice Address - Country:US
Practice Address - Phone:630-655-6100
Practice Address - Fax:630-352-9153
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024351-1235Z00000X
CA13202235Z00000X
IL146014983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist