Provider Demographics
NPI:1407958192
Name:CARSON, LEZLI RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEZLI
Middle Name:RAE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 W 101ST TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2710
Mailing Address - Country:US
Mailing Address - Phone:913-484-7194
Mailing Address - Fax:
Practice Address - Street 1:11608 W 101ST TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2710
Practice Address - Country:US
Practice Address - Phone:913-484-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist