Provider Demographics
NPI:1699014274
Name:EUSTACE, LEAH HOWARD (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:HOWARD
Last Name:EUSTACE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:HOWARD
Other - Last Name:EUSTACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:4607 TIMBERGLEN RD
Mailing Address - Street 2:APT 313
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5237
Mailing Address - Country:US
Mailing Address - Phone:631-721-7274
Mailing Address - Fax:631-841-8879
Practice Address - Street 1:4607 TIMBERGLEN RD
Practice Address - Street 2:APT 313
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5237
Practice Address - Country:US
Practice Address - Phone:631-721-7274
Practice Address - Fax:631-841-8879
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist