Healthcare Provider Details

I. General information

NPI: 1164601902
Provider Name (Legal Business Name): LEAH SKOW M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/21/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 EAST TEXAS ST
VAN TX
75790-7579
US

IV. Provider business mailing address

549 EAST TEXAS ST
VAN TX
75790-3614
US

V. Phone/Fax

Practice location:
  • Phone: 903-963-8710
  • Fax: 817-562-3114
Mailing address:
  • Phone: 903-963-8710
  • Fax: 817-562-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: