| Doctor Name: | IRIS LEYRETANA SUMATRA |
| NPI Number: | 1306983481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | SP-8112 |
| Business Practice Address: | 900 Club Dr Westerville, OH - 430814909 |
| Business Phone Number: | 6148992838 |
| Business Fax Number: | 6148992876 |
| Mailing Address: | 900 Club Dr, WESTERVILLE |
| State: | OH |
| Postal Code: | 430814909 |
| Phone Number: | 6148992838 |
| Fax Number: | 6148992876 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 11/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP-8112 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |