Provider Demographics
NPI:1881731057
Name:RUSIN, LEIGH ANN (MASLP)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:RUSIN
Suffix:
Gender:F
Credentials:MASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 QUEENSHIP CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5966
Mailing Address - Country:US
Mailing Address - Phone:561-968-7152
Mailing Address - Fax:567-968-7152
Practice Address - Street 1:5423 QUEENSHIP CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5966
Practice Address - Country:US
Practice Address - Phone:561-968-7152
Practice Address - Fax:567-968-7152
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist