Provider Demographics
NPI:1497985824
Name:VASS, LESLIE DAWN
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DAWN
Last Name:VASS
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 1:1225 PEMBROKE FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:KY
Mailing Address - Zip Code:42266-9452
Mailing Address - Country:US
Mailing Address - Phone:270-475-9388
Mailing Address - Fax:270-475-9388
Practice Address - Street 1:1225 PEMBROKE FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-9452
Practice Address - Country:US
Practice Address - Phone:270-475-9388
Practice Address - Fax:270-475-9388
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200205652171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor