Most Relevant Information
Provider Data
| NPI Number: | 1003026881 |
| Provider Name: | LEIGH SHANNON ROARK CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 140112 |
Most Important Dates
| Enumeration Date: | 05/23/2007 |
| Last Updated: | 04/05/2017 |
Provider Practice Location
2801 US HIGHWAY 25 E
SUITE 98
MIDDLESBORO
KY
409652069
Practice Location Phone/Fax
| Phone: | 6065452631 |
| Fax: | 6065232256 |
Provider Mailing Location
535 J GOODIN BRANCH RD
BARBOURVILLE
KY
409067563
Provider Mailing Phone/Fax
| Phone: | 6065466513 |
| Fax: | 6065232256 |