Provider Demographics
NPI:1194265710
Name:LINDSEY R. LEESON, M.S., CCC-SLP, P.A.
Entity type:Organization
Organization Name:LINDSEY R. LEESON, M.S., CCC-SLP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-585-7871
Mailing Address - Street 1:6719 GALL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2568
Mailing Address - Country:US
Mailing Address - Phone:352-467-0088
Mailing Address - Fax:813-779-1879
Practice Address - Street 1:6719 GALL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2568
Practice Address - Country:US
Practice Address - Phone:352-467-0088
Practice Address - Fax:813-779-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11458235Z00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114994000Medicaid