Provider Demographics
NPI:1508347352
Name:ANDERSON, LESLIE PAIGE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PAIGE
Last Name:ANDERSON
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 1:5241 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5253
Mailing Address - Country:US
Mailing Address - Phone:870-636-8288
Mailing Address - Fax:
Practice Address - Street 1:4501 DUDMAR DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6913
Practice Address - Country:US
Practice Address - Phone:512-892-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist