Provider Demographics
NPI:1285776443
Name:HOOKER, LEIA TATE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEIA
Middle Name:TATE
Last Name:HOOKER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MS
Other - First Name:LEIA
Other - Middle Name:BROOK
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-0224
Mailing Address - Country:US
Mailing Address - Phone:910-585-1912
Mailing Address - Fax:910-947-3951
Practice Address - Street 1:216 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-0224
Practice Address - Country:US
Practice Address - Phone:910-585-1912
Practice Address - Fax:910-947-3951
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411941Medicaid