Provider Demographics
NPI:1760024798
Name:LEGGETT, MIRANDA JOY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JOY
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:JOY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26431 ELMCREST WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6563
Mailing Address - Country:US
Mailing Address - Phone:949-939-7227
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA SUITE 540
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP24706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist