Provider Demographics
NPI:1003323940
Name:HARRIS, LESLIE MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3104
Mailing Address - Country:US
Mailing Address - Phone:479-495-0657
Mailing Address - Fax:479-495-3617
Practice Address - Street 1:2207 ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3104
Practice Address - Country:US
Practice Address - Phone:479-495-0657
Practice Address - Fax:479-495-3617
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist