Provider Demographics
NPI:1285009860
Name:SELMAN, LESLEY SHANNON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:SHANNON
Last Name:SELMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12151 AUTUMN LEAVES TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-8561
Mailing Address - Country:US
Mailing Address - Phone:205-246-9345
Mailing Address - Fax:
Practice Address - Street 1:3630 NORTHBROOK DR
Practice Address - Street 2:SUITE D
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5822
Practice Address - Country:US
Practice Address - Phone:205-246-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist