Provider Demographics
NPI:1144679259
Name:BOOTHE, LEAH MEGAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MEGAN
Last Name:BOOTHE
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 1:238 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-9683
Mailing Address - Country:US
Mailing Address - Phone:734-664-8289
Mailing Address - Fax:
Practice Address - Street 1:238 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-9683
Practice Address - Country:US
Practice Address - Phone:734-664-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000103235Z00000X
MIL964049235Z00000X
SC6378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist