Provider Demographics
NPI:1750628665
Name:LEROUX, CONNIE (MA CCC-SLP; BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:LEROUX
Suffix:
Gender:F
Credentials:MA CCC-SLP; BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1644
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-0644
Mailing Address - Country:US
Mailing Address - Phone:412-478-4956
Mailing Address - Fax:
Practice Address - Street 1:3700 S HURON RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2065
Practice Address - Country:US
Practice Address - Phone:412-478-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist