Provider Demographics
NPI:1164145231
Name:GIL, LESLIE (MA, MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:MA, MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6613
Mailing Address - Country:US
Mailing Address - Phone:607-793-1860
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:INPATIENT REHABILITATION
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST3780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist