Provider Demographics
NPI:1760948954
Name:DOYLE, LEANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:17918 JUNIPER GREEN TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8810 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3006
Practice Address - Country:US
Practice Address - Phone:936-334-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104779OtherTEXAS SPEECH-LANGUAGE PATHOLOGIST LICENSE
12143812OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE