Provider Demographics
NPI:1942982863
Name:MARQUEZ, LEIGH ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:WALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0697
Mailing Address - Country:US
Mailing Address - Phone:606-372-1234
Mailing Address - Fax:606-372-1240
Practice Address - Street 1:713 BROADWAY ST STE 301A
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1465
Practice Address - Country:US
Practice Address - Phone:606-372-1234
Practice Address - Fax:606-372-1240
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY139717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100918140Medicaid