Provider Demographics
NPI:1144629411
Name:MCKINNEY, LEDEITHRA DENISE (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LEDEITHRA
Middle Name:DENISE
Last Name:MCKINNEY
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 1:1514 GLENWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1118
Mailing Address - Country:US
Mailing Address - Phone:419-377-9377
Mailing Address - Fax:
Practice Address - Street 1:1921 EAST GYPSY LANE RD.
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402
Practice Address - Country:US
Practice Address - Phone:419-354-9010
Practice Address - Fax:419-352-9602
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist