Provider Demographics
NPI:1992348825
Name:CONAWAY, LEAH RAE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:CONAWAY
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1409
Mailing Address - Country:US
Mailing Address - Phone:573-265-2300
Mailing Address - Fax:
Practice Address - Street 1:122 E SCIOTO ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1718
Practice Address - Country:US
Practice Address - Phone:573-265-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist