Provider Demographics
NPI:1508343724
Name:ROE, LESLIE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ROE
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 1:8500 ROCKWAY ST
Mailing Address - Street 2:
Mailing Address - City:WHITE SETTLEMENT
Mailing Address - State:TX
Mailing Address - Zip Code:76108-1324
Mailing Address - Country:US
Mailing Address - Phone:817-367-1327
Mailing Address - Fax:817-367-1340
Practice Address - Street 1:8500 ROCKWAY ST
Practice Address - Street 2:
Practice Address - City:WHITE SETTLEMENT
Practice Address - State:TX
Practice Address - Zip Code:76108-1324
Practice Address - Country:US
Practice Address - Phone:817-367-1327
Practice Address - Fax:817-367-1340
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist