Provider Demographics
NPI:1780229773
Name:LBF SPEECH COMMUNICATION CONSULTING SERVICES
Entity Type:Organization
Organization Name:LBF SPEECH COMMUNICATION CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEASONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOZER-FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:210-792-9722
Mailing Address - Street 1:15314 ALBRECHT LN
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1849
Mailing Address - Country:US
Mailing Address - Phone:210-792-9722
Mailing Address - Fax:
Practice Address - Street 1:15314 ALBRECHT LN
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1849
Practice Address - Country:US
Practice Address - Phone:210-792-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105498OtherSPEECH LICENSE