Provider Demographics
NPI:1821468570
Name:ROTHWELL, LEAH (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ROTHWELL
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18725 DALLAS PKWY
Mailing Address - Street 2:1413
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4239
Mailing Address - Country:US
Mailing Address - Phone:407-285-9086
Mailing Address - Fax:
Practice Address - Street 1:101 SUMMIT AVE
Practice Address - Street 2:510
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2618
Practice Address - Country:US
Practice Address - Phone:682-730-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110550235Z00000X
CASP25632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty