Provider Demographics
NPI:1861510802
Name:LEYHUE, STEPHENIE SIMS (SLP, AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:STEPHENIE
Middle Name:SIMS
Last Name:LEYHUE
Suffix:
Gender:F
Credentials:SLP, AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KENNEDY DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3341
Mailing Address - Country:US
Mailing Address - Phone:731-281-4407
Mailing Address - Fax:731-588-5739
Practice Address - Street 1:145 KENNEDY DR STE B
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3341
Practice Address - Country:US
Practice Address - Phone:731-281-4407
Practice Address - Fax:731-588-5739
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA 0000001052237600000X
TNSP 0000002750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN83-2622920OtherTIN
TN20-5852336OtherTIN