Provider Demographics
NPI:1134300429
Name:LESLIE, BRANDI SUZANNE
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:SUZANNE
Last Name:LESLIE
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 1:717 CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-7478
Mailing Address - Country:US
Mailing Address - Phone:816-288-1897
Mailing Address - Fax:
Practice Address - Street 1:717 CLAYTON DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:MO
Practice Address - Zip Code:64076-7478
Practice Address - Country:US
Practice Address - Phone:816-288-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist