Provider Demographics
NPI:1306935127
Name:THOMPSON, LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 W POWERLINE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3370
Mailing Address - Country:US
Mailing Address - Phone:479-409-4191
Mailing Address - Fax:479-271-7633
Practice Address - Street 1:547 W POWERLINE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3370
Practice Address - Country:US
Practice Address - Phone:479-409-4191
Practice Address - Fax:479-271-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160970721Medicaid
AR5Y968OtherBLUECROSSBLUESHIELD PROV.