Provider Demographics
NPI:1316001662
Name:HUSK, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NORTH ST,
Mailing Address - Street 2:ANNEX B
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714
Mailing Address - Country:US
Mailing Address - Phone:417-724-4040
Mailing Address - Fax:417-724-4039
Practice Address - Street 1:205 NORTH ST,
Practice Address - Street 2:ANNEX B
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714
Practice Address - Country:US
Practice Address - Phone:417-724-4040
Practice Address - Fax:417-724-4039
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist