Provider Demographics
NPI:1154742062
Name:DAGGETT, LEIGH-ANNE
Entity type:Individual
Prefix:
First Name:LEIGH-ANNE
Middle Name:
Last Name:DAGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19097 SYCAMORE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1082
Mailing Address - Country:US
Mailing Address - Phone:949-521-3215
Mailing Address - Fax:
Practice Address - Street 1:20996 BAKE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2169
Practice Address - Country:US
Practice Address - Phone:949-600-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist