Healthcare Provider Details

I. General information

NPI: 1972974848
Provider Name (Legal Business Name): LEANN EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 ABBINGTON ST
HENDERSON NV
89074-5962
US

IV. Provider business mailing address

321 ABBINGTON ST
HENDERSON NV
89074-5962
US

V. Phone/Fax

Practice location:
  • Phone: 702-286-2730
  • Fax:
Mailing address:
  • Phone: 702-286-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1474
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: