Provider Demographics
NPI:1497485239
Name:BECKER, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:UTOPIA
Mailing Address - State:TX
Mailing Address - Zip Code:78884-0443
Mailing Address - Country:US
Mailing Address - Phone:361-215-9056
Mailing Address - Fax:
Practice Address - Street 1:900 N PICKFORD
Practice Address - Street 2:
Practice Address - City:SABINAL
Practice Address - State:TX
Practice Address - Zip Code:78881
Practice Address - Country:US
Practice Address - Phone:830-988-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist