Provider Demographics
NPI:1174770051
Name:NORBOTTEN, LEA DAWN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:DAWN
Last Name:NORBOTTEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:LEA
Other - Middle Name:DAWN
Other - Last Name:STACHURSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1080 E STERNBERG RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-8796
Mailing Address - Country:US
Mailing Address - Phone:231-799-2200
Mailing Address - Fax:231-799-2201
Practice Address - Street 1:1080 E STERNBERG RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-8796
Practice Address - Country:US
Practice Address - Phone:231-799-2200
Practice Address - Fax:231-799-2201
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12003580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist