Healthcare Provider Details

I. General information

NPI: 1487566600
Provider Name (Legal Business Name): JESSICA LEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W OREGON ST
LAPEER MI
48446-1122
US

IV. Provider business mailing address

5883 REYNOLDS RD
IMLAY CITY MI
48444-9811
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-2440
  • Fax:
Mailing address:
  • Phone: 734-778-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: