Provider Demographics
NPI:1902094618
Name:HOLLAND, LEIGH E (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:E
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 STATE HIGHWAY Z
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-7165
Mailing Address - Country:US
Mailing Address - Phone:573-472-3713
Mailing Address - Fax:
Practice Address - Street 1:5870 STATE HIGHWAY Z
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-7165
Practice Address - Country:US
Practice Address - Phone:573-472-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002000492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist