Provider Demographics
NPI:1255900783
Name:WALSH, LEAH TUCKER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:TUCKER
Last Name:WALSH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LACEYS SPRING
Mailing Address - State:AL
Mailing Address - Zip Code:35754-7221
Mailing Address - Country:US
Mailing Address - Phone:256-655-2380
Mailing Address - Fax:
Practice Address - Street 1:80 WESTVIEW LN
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-7221
Practice Address - Country:US
Practice Address - Phone:256-655-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist