Provider Demographics
NPI:1194337550
Name:GREEN, LEAH ELIZABETH (MA CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8530
Mailing Address - Country:US
Mailing Address - Phone:614-326-9473
Mailing Address - Fax:
Practice Address - Street 1:2521 FAIRWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2712
Practice Address - Country:US
Practice Address - Phone:614-237-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist