Provider Demographics
NPI:1962681049
Name:COWAN, LEIGH (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PEAVINE PLZ
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-7965
Mailing Address - Country:US
Mailing Address - Phone:931-484-6073
Mailing Address - Fax:931-484-6949
Practice Address - Street 1:44 PEAVINE PLZ
Practice Address - Street 2:SUITE 103
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38571-7965
Practice Address - Country:US
Practice Address - Phone:931-484-6073
Practice Address - Fax:931-484-6949
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001111231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4036792OtherBLUE CROSS BLUE SHIELD
3192852Medicare PIN