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General NPI Number Information
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NPI Number | 1104379585
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Entity Type | Individual
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Provider Name | LEAH MICIOTTO MCD, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 9990 RICHMOND AVE HOUSTON
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City | HOUSTON
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State | TX
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Zip | 77042-4559
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Country | US
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Telephone | 713-783-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 13734 MCKINNEY CREEK LN
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City | HOUSTON
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State | TX
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Zip | 77044-1057
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Country | US
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Telephone | 713-291-3386
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 101926
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License Number State | TX
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