MEDICARE: MRS. LEAH HOWARD EUSTACE M.A. 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	108476	TX

General Provider Information

NPI Number	:	1699014274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH HOWARD EUSTACE M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	4607 TIMBERGLEN RD
Second Line	:	APT 313
City	:	DALLAS
State	:	TX
Zip	:	75287-5237
Country	:	US
Telephone Number	:	631-721-7274
Fax Number	:	631-841-8879

Provider Business Practice Location Address
First Line	:	4607 TIMBERGLEN RD
Second Line	:	APT 313
City	:	DALLAS
State	:	TX
Zip	:	75287-5237
Country	:	US
Telephone Number	:	631-721-7274
Fax Number	:	631-841-8879

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

Provider Enumeration Date	:	02/02/2013
Last Update Date	:	02/02/2013

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