MEDICARE: MITZI LYNN LEAHY M.S., 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	112765	TX

General Provider Information

NPI Number	:	1811319270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITZI LYNN LEAHY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2715 SEABISCUIT RD
Second Line	:
City	:	CELINA
State	:	TX
Zip	:	75009-1424
Country	:	US
Telephone Number	:	214-856-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 TIMBER LAKE TRL
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-8608
Country	:	US
Telephone Number	:	678-456-8978
Fax Number	:

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

Provider Enumeration Date	:	01/20/2014
Last Update Date	:	07/21/2022

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Directions to “ MITZI LYNN LEAHY M.S., CCC-SLP” Practice Location

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