Provider Demographics
NPI:1174649271
Name:CHILDS, LESLIE LYNETTE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LYNETTE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LYNETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2004 OLD MAY CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3883
Mailing Address - Country:US
Mailing Address - Phone:859-321-0932
Mailing Address - Fax:
Practice Address - Street 1:3206 LONGMIRE DR STE A23
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5858
Practice Address - Country:US
Practice Address - Phone:859-321-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2397235Z00000X
TX104796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist