Provider Demographics
NPI:1437454014
Name:LEESON, LINDSEY RENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:RENE
Last Name:LEESON
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 1:6719 GALL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2568
Mailing Address - Country:US
Mailing Address - Phone:352-467-0088
Mailing Address - Fax:813-779-1879
Practice Address - Street 1:6719 GALL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2568
Practice Address - Country:US
Practice Address - Phone:352-467-0088
Practice Address - Fax:813-779-1879
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017039100Medicaid