Provider Demographics
NPI:1528736154
Name:MCCOMACK, LEAH JUHREE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JUHREE
Last Name:MCCOMACK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:JUHREE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6845
Mailing Address - Country:US
Mailing Address - Phone:580-371-6357
Mailing Address - Fax:
Practice Address - Street 1:724 24TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6214
Practice Address - Country:US
Practice Address - Phone:405-447-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist