Provider Demographics
NPI:1649506247
Name:LOTT, LEIGH ANNA (SLP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNA
Last Name:LOTT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TRAILWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-6466
Mailing Address - Country:US
Mailing Address - Phone:601-795-3509
Mailing Address - Fax:601-403-8162
Practice Address - Street 1:15 TRAILWOOD LN
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-6466
Practice Address - Country:US
Practice Address - Phone:601-795-3509
Practice Address - Fax:601-403-8162
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist