Provider Demographics
NPI:1841640802
Name:CLEVELAND, LEA NIBLETT
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:NIBLETT
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:ANN
Other - Last Name:NIBLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-SLP-CCC
Mailing Address - Street 1:2222 SULLIVAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040
Mailing Address - Country:US
Mailing Address - Phone:610-438-2020
Mailing Address - Fax:
Practice Address - Street 1:2222 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-7958
Practice Address - Country:US
Practice Address - Phone:610-438-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist