Provider Demographics
NPI:1063636421
Name:ISAACSON, LESLY
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 W CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4426
Mailing Address - Country:US
Mailing Address - Phone:623-975-3561
Mailing Address - Fax:
Practice Address - Street 1:6150 W GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3724
Practice Address - Country:US
Practice Address - Phone:602-467-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist