Provider Demographics
NPI:1356632046
Name:QUINN, LESLEY (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:QUINN
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 1:106 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1811
Mailing Address - Country:US
Mailing Address - Phone:413-534-2508
Mailing Address - Fax:
Practice Address - Street 1:106 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1811
Practice Address - Country:US
Practice Address - Phone:413-534-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist