Provider Demographics
NPI:1366982084
Name:CORBETT, LEAH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 SW UTTERBACK ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6111
Mailing Address - Country:US
Mailing Address - Phone:856-889-5974
Mailing Address - Fax:
Practice Address - Street 1:4183 SW UTTERBACK ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6111
Practice Address - Country:US
Practice Address - Phone:856-889-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7686235Z00000X
FLSA15829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist