Provider Demographics
NPI:1003181603
Name:COTHRAN, LESLEE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:COTHRAN
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 1:432 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3100
Mailing Address - Country:US
Mailing Address - Phone:517-290-1390
Mailing Address - Fax:
Practice Address - Street 1:5400 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4049
Practice Address - Country:US
Practice Address - Phone:517-393-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist