Provider Demographics
NPI:1124536719
Name:FERGUSON, LESLIE NICOLE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NICOLE
Last Name:FERGUSON
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 1:881 KY ROUTE 689 E
Mailing Address - Street 2:
Mailing Address - City:FLATGAP
Mailing Address - State:KY
Mailing Address - Zip Code:41219-9546
Mailing Address - Country:US
Mailing Address - Phone:606-265-8891
Mailing Address - Fax:606-265-4409
Practice Address - Street 1:881 KY ROUTE 689 E
Practice Address - Street 2:
Practice Address - City:FLATGAP
Practice Address - State:KY
Practice Address - Zip Code:41219-9546
Practice Address - Country:US
Practice Address - Phone:606-265-8891
Practice Address - Fax:606-265-4409
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist