Provider Demographics
NPI:1154774081
Name:CULBERTSON, LEANNE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2350
Mailing Address - Country:US
Mailing Address - Phone:423-534-7662
Mailing Address - Fax:
Practice Address - Street 1:9041 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 126
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4621
Practice Address - Country:US
Practice Address - Phone:423-534-7662
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist