Provider Demographics
NPI:1043785520
Name:LYNCH, LESLIE ANN (SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:LYNCH
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:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-1091
Mailing Address - Country:US
Mailing Address - Phone:423-254-1978
Mailing Address - Fax:423-289-1072
Practice Address - Street 1:958 TRADE ST STE 102
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5773
Practice Address - Country:US
Practice Address - Phone:423-254-1978
Practice Address - Fax:423-289-1072
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist