MEDICARE: DEBORAH LEACH CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP1483	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568530624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH LEACH CCC-SLP

Provider Business Mailing Address
First Line	:	300 W CLARENDON AVE STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3421
Country	:	US
Telephone Number	:	602-601-5382
Fax Number	:	602-207-8620

Provider Business Practice Location Address
First Line	:	300 W CLARENDON AVE STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3421
Country	:	US
Telephone Number	:	602-601-5382
Fax Number	:	602-207-8620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	11/08/2018

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Directions to “ DEBORAH LEACH CCC-SLP” Practice Location

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