Provider Demographics
NPI:1730415290
Name:LEIJA, LAUREN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:LEIJA
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 1:14153 RICK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2951
Mailing Address - Country:US
Mailing Address - Phone:586-933-3387
Mailing Address - Fax:
Practice Address - Street 1:301 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1407
Practice Address - Country:US
Practice Address - Phone:248-486-1110
Practice Address - Fax:248-486-3318
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12109190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist