Provider Demographics
NPI:1124211552
Name:GARTHAUS, LESLIE ANN (MS,CCC-SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:GARTHAUS
Suffix:
Gender:F
Credentials:MS,CCC-SLP-L
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:HARMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP-L
Mailing Address - Street 1:26 WATERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2921
Mailing Address - Country:US
Mailing Address - Phone:309-530-6982
Mailing Address - Fax:
Practice Address - Street 1:26 WATERSIDE CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2921
Practice Address - Country:US
Practice Address - Phone:309-530-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist