Provider Demographics
NPI:1104216217
Name:VANDYCK, LESLEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:VANDYCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4219
Mailing Address - Country:US
Mailing Address - Phone:980-237-3132
Mailing Address - Fax:
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4219
Practice Address - Country:US
Practice Address - Phone:980-237-3132
Practice Address - Fax:704-457-1097
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14046651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist