Provider Demographics
NPI:1083973747
Name:MCMAHON, LEIGH ANN R (SLP)
Entity type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:R
Last Name:MCMAHON
Suffix:
Gender:F
Credentials: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 566 HWY 589
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482
Mailing Address - Country:US
Mailing Address - Phone:601-336-9099
Mailing Address - Fax:601-550-6184
Practice Address - Street 1:4881 HWY 589
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482
Practice Address - Country:US
Practice Address - Phone:601-336-9099
Practice Address - Fax:601-550-6184
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MSS-3656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist