Most Relevant Information
Provider Data
| NPI Number: | 1003396896 |
| Provider Name: | LEAH REILLY NICHOLS CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | SLP010245 |
Most Important Dates
| Enumeration Date: | 08/21/2018 |
| Last Updated: | 07/01/2019 |
Provider Practice Location
3044 DUE WEST ROAD
DALLAS
GA
301573015
Practice Location Phone/Fax
| Phone: | 7704439672 |
| Fax: |
Provider Mailing Location
3044 DUE WEST RD
DALLAS
GA
301572125
Provider Mailing Phone/Fax
| Phone: | 7704439672 |
| Fax: |