Provider Demographics
NPI:1154679355
Name:BOLLAG, LEAH
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BOLLAG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:BOLLAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1664 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2546
Mailing Address - Country:US
Mailing Address - Phone:718-705-8859
Mailing Address - Fax:
Practice Address - Street 1:1664 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2546
Practice Address - Country:US
Practice Address - Phone:718-705-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist