Provider Demographics
NPI:1023176112
Name:KENDRICK, LEAH K (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 ALCOVY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4758
Mailing Address - Country:US
Mailing Address - Phone:770-558-0100
Mailing Address - Fax:
Practice Address - Street 1:607 ALCOVY RIVER DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4758
Practice Address - Country:US
Practice Address - Phone:770-558-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000571491GMedicaid