Provider Demographics
NPI:1457308272
Name:SOILES, LESLIE PETERSON
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PETERSON
Last Name:SOILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JEAN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 JULIO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3053
Mailing Address - Country:US
Mailing Address - Phone:508-845-5500
Mailing Address - Fax:508-845-5508
Practice Address - Street 1:24 JULIO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3053
Practice Address - Country:US
Practice Address - Phone:508-845-5500
Practice Address - Fax:508-845-5508
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SO-022064Medicare ID - Type Unspecified
P42170Medicare UPIN