Provider Demographics
NPI:1295112274
Name:LEYRER, GINA MORAN (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MORAN
Last Name:LEYRER
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:RAIE
Other - Last Name:LEYRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:16846 WEYANOKE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-8844
Mailing Address - Country:US
Mailing Address - Phone:225-405-6758
Mailing Address - Fax:225-261-0005
Practice Address - Street 1:16846 WEYANOKE DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-8844
Practice Address - Country:US
Practice Address - Phone:225-405-6758
Practice Address - Fax:225-261-2987
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist