Provider Demographics
NPI:1841646031
Name:DEBORAH LEACH SPEECH LANGUAGE PATHOLOGY GROUP PLLC
Entity type:Organization
Organization Name:DEBORAH LEACH SPEECH LANGUAGE PATHOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:602-601-5382
Mailing Address - Street 1:500 W THOMAS RD
Mailing Address - Street 2:SUITE 960
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4224
Mailing Address - Country:US
Mailing Address - Phone:602-266-9066
Mailing Address - Fax:602-266-5711
Practice Address - Street 1:300 W CLARENDON AVE STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3421
Practice Address - Country:US
Practice Address - Phone:602-601-5382
Practice Address - Fax:602-207-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ705056Medicaid