Provider Demographics
NPI:1932402724
Name:LEACHMAN, BEVERLY JEAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:LEACHMAN
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 1:5415 W GALE CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-8468
Mailing Address - Country:US
Mailing Address - Phone:816-803-8802
Mailing Address - Fax:
Practice Address - Street 1:5415 W GALE CIR
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8468
Practice Address - Country:US
Practice Address - Phone:816-803-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist