Healthcare Provider Details

I. General information

NPI: 1548777238
Provider Name (Legal Business Name): ANDREA HALL-LEONARD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHAMPTON COUNTY PUBLIC SCHOOLS 21290 PLANK ROAD
COURTLAND VA
23837
US

IV. Provider business mailing address

214 THOMAS ST
FRANKLIN VA
23851-2608
US

V. Phone/Fax

Practice location:
  • Phone: 757-774-8925
  • Fax:
Mailing address:
  • Phone: 757-774-8925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2203000590
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: