Provider Demographics
NPI:1942474432
Name:WILLIAMS, LEAH LANETTE (MCDCCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:LANETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MCDCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ISLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4741
Mailing Address - Country:US
Mailing Address - Phone:318-210-5711
Mailing Address - Fax:
Practice Address - Street 1:1105 ISLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4741
Practice Address - Country:US
Practice Address - Phone:318-210-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5547OtherSPEECH-LANGUAGE PATHOLOGY