Provider Demographics
NPI:1083328900
Name:MAGEE, LESLIE (HIS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MAGEE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E SUNBRIDGE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2857
Mailing Address - Country:US
Mailing Address - Phone:479-443-2210
Mailing Address - Fax:479-587-9455
Practice Address - Street 1:61 E SUNBRIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2857
Practice Address - Country:US
Practice Address - Phone:479-443-2210
Practice Address - Fax:479-587-9455
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR673237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist