Provider Demographics
NPI:1760692552
Name:STANLEY, LEANN DAVIS (MEDCCCSLP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:DAVIS
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MEDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 STANLEY RETREAT DR
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-2749
Mailing Address - Country:US
Mailing Address - Phone:912-565-0700
Mailing Address - Fax:
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8845
Practice Address - Country:US
Practice Address - Phone:912-277-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist