Provider Demographics
NPI:1558512640
Name:SLATER, LESLI RIDER (AUD)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:RIDER
Last Name:SLATER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:
Other - Last Name:RIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191693
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8504
Mailing Address - Country:US
Mailing Address - Phone:720-289-9836
Mailing Address - Fax:
Practice Address - Street 1:2950 MCKINNEY AVE APT 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2483
Practice Address - Country:US
Practice Address - Phone:720-289-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO492237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO303164Medicare PIN