Provider Demographics
NPI:1699317792
Name:NESBURG, LEAH GRACE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:GRACE
Last Name:NESBURG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:GRACE
Other - Last Name:BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:600 3 MILE ROAD NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544
Mailing Address - Country:US
Mailing Address - Phone:616-666-6396
Mailing Address - Fax:616-259-4207
Practice Address - Street 1:600 3 MILE ROAD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544
Practice Address - Country:US
Practice Address - Phone:616-666-6396
Practice Address - Fax:616-259-4207
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist