Provider Demographics
NPI:1245009596
Name:ALLBAUGH, LEA
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:ALLBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:QUIMBY
Mailing Address - State:IA
Mailing Address - Zip Code:51049-0142
Mailing Address - Country:US
Mailing Address - Phone:712-261-3010
Mailing Address - Fax:
Practice Address - Street 1:4300 S LAKEPORT ST STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9533
Practice Address - Country:US
Practice Address - Phone:605-210-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist