Provider Demographics
NPI:1528464195
Name:SELENGUT, LEAH (MS/SLP)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:SELENGUT
Suffix:
Gender:F
Credentials:MS/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 KEDMA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3599
Mailing Address - Country:US
Mailing Address - Phone:732-905-8308
Mailing Address - Fax:732-905-8308
Practice Address - Street 1:23 KEDMA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3599
Practice Address - Country:US
Practice Address - Phone:732-905-8308
Practice Address - Fax:732-905-8308
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00590100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist