Provider Demographics
NPI:1689349680
Name:WESTBERRY, LEANNA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:WESTBERRY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:
Other - Last Name:REDDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 CORAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3016
Mailing Address - Country:US
Mailing Address - Phone:912-342-8875
Mailing Address - Fax:912-342-8016
Practice Address - Street 1:212 NE BROAD ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31546-4371
Practice Address - Country:US
Practice Address - Phone:912-342-8875
Practice Address - Fax:912-342-8016
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP010460OtherSLP LICENSE