MEDICARE: LEAH JOHANNA MARTIN 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	SLP.0004163	CO

General Provider Information

NPI Number	:	1932319902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH JOHANNA MARTIN M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	6444 N ENSENADA CT
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80019-2167
Country	:	US
Telephone Number	:	602-405-5789
Fax Number	:	504-324-0706

Provider Business Practice Location Address
First Line	:	6444 N ENSENADA CT
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80019-2167
Country	:	US
Telephone Number	:	602-405-5789
Fax Number	:	504-324-0706

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/16/2024

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