=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245959790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL ELAINE LEAMON SPEECH PATHOLOGIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2022
-----------------------------------------------------
Last Update Date | 08/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 W. KNOX ST.
-----------------------------------------------------
City | ENNIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-872-7040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 BLUE RIBBON RD
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-935-2443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 11960
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------