Healthcare Provider Details

I. General information

NPI: 1154742062
Provider Name (Legal Business Name): LEIGH-ANNE DAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20996 BAKE PKWY STE 106
LAKE FOREST CA
92630-2169
US

IV. Provider business mailing address

19097 SYCAMORE GLEN DR
TRABUCO CANYON CA
92679-1082
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-5437
  • Fax:
Mailing address:
  • Phone: 949-521-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP16190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: