Provider Demographics
NPI:1407085822
Name:PATRICK, LESLIE ALICIA (MA, SLP/TSSLD)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ALICIA
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, SLP/TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 LACOMBE AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:646-505-9573
Mailing Address - Fax:
Practice Address - Street 1:511 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552
Practice Address - Country:US
Practice Address - Phone:515-656-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019173-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist