Provider Demographics
NPI:1225151749
Name:BUCK, LESLIE HEGAN (MA CCC SLP L)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:HEGAN
Last Name:BUCK
Suffix:
Gender:F
Credentials:MA CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 KENT DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1847
Mailing Address - Country:US
Mailing Address - Phone:573-334-8099
Mailing Address - Fax:
Practice Address - Street 1:2136 KENT DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1847
Practice Address - Country:US
Practice Address - Phone:573-334-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002028081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist