Provider Demographics
NPI:1376113217
Name:LEWIS, LESLIE STARK (MS, SLP-INTERN)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:STARK
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E ASHBY PL APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3895
Mailing Address - Country:US
Mailing Address - Phone:210-609-0398
Mailing Address - Fax:
Practice Address - Street 1:1635 NE INTERSTATE 410 LOOP
Practice Address - Street 2:STE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-457-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist