Provider Demographics
NPI:1063143667
Name:SHUMATE, LEIGH ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANNE
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-0042
Mailing Address - Country:US
Mailing Address - Phone:606-269-3178
Mailing Address - Fax:
Practice Address - Street 1:211 N 30TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2220
Practice Address - Country:US
Practice Address - Phone:606-269-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY243326235Z00000X
CA31814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist