Healthcare Provider Details

I. General information

NPI: 1396908885
Provider Name (Legal Business Name): LEAH GRAHAM PITTS MSCCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH HAYNES GRAHAM

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 CEDAR LN APT. 150
COLUMBIA MD
21044-3897
US

IV. Provider business mailing address

200 NORTHPOINTE CIR STE. 302
SEVEN FIELDS PA
16046-7861
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-6000
  • Fax: 410-531-3402
Mailing address:
  • Phone: 800-815-8577
  • Fax: 724-779-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number05771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: