Provider Demographics
NPI:1417004037
Name:JOLLES, LESLIE GOTTLIEB (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:GOTTLIEB
Last Name:JOLLES
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 1:7350 TALBOT COLONY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1625
Mailing Address - Country:US
Mailing Address - Phone:404-822-7373
Mailing Address - Fax:
Practice Address - Street 1:7350 TALBOT COLONY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1625
Practice Address - Country:US
Practice Address - Phone:404-822-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA167194116AMedicaid