Provider Demographics
NPI:1407815426
Name:IRVIN, LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:IRVIN
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 1:2520 BURNWYCK CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1833
Mailing Address - Country:US
Mailing Address - Phone:229-883-9910
Mailing Address - Fax:229-883-4484
Practice Address - Street 1:2520 BURNWYCK CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1833
Practice Address - Country:US
Practice Address - Phone:229-883-9910
Practice Address - Fax:229-883-4484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist