Provider Demographics
NPI:1922196039
Name:LEA, KATHLEEN (CCC-A)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LEA
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HALEY CENTER
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-9600
Mailing Address - Fax:334-844-9684
Practice Address - Street 1:1199 HALEY CENTER
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-1931
Practice Address - Country:US
Practice Address - Phone:344-844-9600
Practice Address - Fax:334-844-9684
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003628231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA737441936AMedicaid