MEDICARE: MRS. LEAH MUSGRAVE

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		WV

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	:	1639356439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH MUSGRAVE

Provider Business Mailing Address
First Line	:	100 KINGSDALE DR
Second Line	:
City	:	DELBARTON
State	:	WV
Zip	:	25670-6061
Country	:	US
Telephone Number	:	304-785-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 KINGSDALE DR
Second Line	:
City	:	DELBARTON
State	:	WV
Zip	:	25670
Country	:	US
Telephone Number	:	304-785-8310
Fax Number	:

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	07/09/2024

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Directions to “ MRS. LEAH MUSGRAVE ” Practice Location

Language	Start Address	Practice Location

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