Provider Demographics
NPI:1720872435
Name:BLACK, LEAH DANIELLE
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DANIELLE
Last Name:BLACK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2717
Mailing Address - Country:US
Mailing Address - Phone:248-266-1221
Mailing Address - Fax:248-771-1221
Practice Address - Street 1:6611 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-2717
Practice Address - Country:US
Practice Address - Phone:248-266-1221
Practice Address - Fax:248-771-1221
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist