Doctor Name: | SAMANTHA LEYSE |
NPI Number: | 1356703391 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | PCET002247 |
Business Practice Address: | 200 Perry House Rd Fitzgerald, GA - 317508857 |
Business Phone Number: | 2294247104 |
Business Fax Number: | 2294247122 |
Mailing Address: | 200 Perry House Rd, P O Box 1447 FITZGERALD |
State: | GA |
Postal Code: | 317508857 |
Phone Number: | 2294247104 |
Fax Number: | 2294247122 |
NPI Enumeration Date: | 03/28/2016 |
NPI Last Update Date: | 03/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | PCET002247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |