Provider Demographics
NPI:1821461641
Name:HARTLEY, LEILA (PHD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:HARTLEY
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:PO BOX 19037
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31126-1037
Mailing Address - Country:US
Mailing Address - Phone:404-812-9875
Mailing Address - Fax:404-841-1944
Practice Address - Street 1:245 W WIEUCA RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3372
Practice Address - Country:US
Practice Address - Phone:404-812-9875
Practice Address - Fax:404-841-1944
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist