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SAMANTHA LEYSE
>> Speech-Language Pathologist >> Speech, Language and Hearing Service ProvidersRegistrant NPI Number: 1356703391
Individual Registrant: SAMANTHA LEYSE
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
200 PERRY HOUSE RD FITZGERALD, GA 31750-8857 US
Tel: 229-424-7104 Fax: 229-424-7122
Tel: 229-424-7104 Fax: 229-424-7122
Contact information for business:
200 PERRY HOUSE RD P O BOX 1447 FITZGERALD, GA 31750-8857 US
Tel: 229-424-7104 Fax: 229-424-7122
Tel: 229-424-7104 Fax: 229-424-7122
Registration Information:
NPI: 1356703391
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 235Z00000X | Speech, Language and Hearing Service Providers Speech-Language Pathologist | GA | PCET002247 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
