Provider Demographics
NPI:1770341281
Name:NEILSON-JOHNSON, LEAH JEAH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAH
Last Name:NEILSON-JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 EL MONTE PL
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2502
Mailing Address - Country:US
Mailing Address - Phone:719-685-2640
Mailing Address - Fax:
Practice Address - Street 1:405 EL MONTE PL
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2502
Practice Address - Country:US
Practice Address - Phone:719-685-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO255836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist