Provider Demographics
NPI:1760520225
Name:SPELL, LEIGH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:SPELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CEDAR CREST LN
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7931
Mailing Address - Country:US
Mailing Address - Phone:803-732-7153
Mailing Address - Fax:
Practice Address - Street 1:104 CEDAR CREST LN
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7931
Practice Address - Country:US
Practice Address - Phone:803-732-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0032Medicaid