Provider Demographics
NPI:1033783485
Name:LEBLANC, BIANCA LISSETTE (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:LISSETTE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14827 PRESTON RD APT 1002
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9119
Mailing Address - Country:US
Mailing Address - Phone:832-283-8271
Mailing Address - Fax:
Practice Address - Street 1:5850 TOWN AND COUNTRY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6944
Practice Address - Country:US
Practice Address - Phone:817-345-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist