Provider Demographics
NPI:1275671240
Name:AYLOR, LESLIE LINDSAY (MED, CCC SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LINDSAY
Last Name:AYLOR
Suffix:
Gender:F
Credentials:MED, CCC SLP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LINDSAY
Other - Last Name:MATTACOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10410 NEW CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SPOUT SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24593-2820
Mailing Address - Country:US
Mailing Address - Phone:434-547-7757
Mailing Address - Fax:
Practice Address - Street 1:1317 LOLA AVE
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517
Practice Address - Country:US
Practice Address - Phone:434-369-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist