Provider Demographics
NPI:1134603863
Name:MCLEOD, SUE ANN (HIS APPRENTICE)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:HIS APPRENTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 S PECOS RD STE 23C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7148
Mailing Address - Country:US
Mailing Address - Phone:725-333-4327
Mailing Address - Fax:702-921-6370
Practice Address - Street 1:8905 S PECOS RD STE 23C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7148
Practice Address - Country:US
Practice Address - Phone:725-333-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-0566237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist