Provider Demographics
NPI:1578532834
Name:MCCREIGHT, LESLIE ANN (AUD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:MCCREIGHT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MARYS AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5894
Mailing Address - Country:US
Mailing Address - Phone:845-334-3121
Mailing Address - Fax:845-334-4789
Practice Address - Street 1:105 MARYS AVENUE
Practice Address - Street 2:BENEDICTINE AUDIOLOGY
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5894
Practice Address - Country:US
Practice Address - Phone:518-262-4535
Practice Address - Fax:518-262-8389
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001900231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOTH000Medicare UPIN