Provider Demographics
NPI:1073778544
Name:EDWARDS-GAITHER, LESLEY (PHD CCC SLP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:EDWARDS-GAITHER
Suffix:
Gender:F
Credentials:PHD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 PAPPAS WAY
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4562
Mailing Address - Country:US
Mailing Address - Phone:937-672-3640
Mailing Address - Fax:
Practice Address - Street 1:8619 PAPPAS WAY
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-4562
Practice Address - Country:US
Practice Address - Phone:937-672-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5836235Z00000X
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist