Provider Demographics
NPI:1568610897
Name:GRUBLER, LESLIE A (MA, CCC-SLP,TSHH)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:GRUBLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206A BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2862
Mailing Address - Country:US
Mailing Address - Phone:917-355-5060
Mailing Address - Fax:718-224-0103
Practice Address - Street 1:21245 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1901
Practice Address - Country:US
Practice Address - Phone:917-355-5060
Practice Address - Fax:718-224-0103
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010959-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist