Provider Demographics
NPI:1417788837
Name:LEEDOM, LINDSEY BRENNA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BRENNA
Last Name:LEEDOM
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 1:409 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2336
Mailing Address - Country:US
Mailing Address - Phone:509-576-0800
Mailing Address - Fax:
Practice Address - Street 1:409 N 2ND ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2336
Practice Address - Country:US
Practice Address - Phone:509-576-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60337004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist