Provider Demographics
NPI:1033458039
Name:DAVIS, LESLIE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12136 KAY DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2600
Mailing Address - Country:US
Mailing Address - Phone:848-333-7369
Mailing Address - Fax:
Practice Address - Street 1:12136 KAY DR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2600
Practice Address - Country:US
Practice Address - Phone:848-333-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist