Provider Demographics
NPI:1477718260
Name:LESLIE, REAGAN C (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:C
Last Name:LESLIE
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 1:28 MEADOW LARK LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2313
Mailing Address - Country:US
Mailing Address - Phone:870-204-2948
Mailing Address - Fax:
Practice Address - Street 1:525 OLD BELLEFONTE RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5542
Practice Address - Country:US
Practice Address - Phone:870-743-9100
Practice Address - Fax:870-743-9099
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist