Provider Demographics
NPI:1598721532
Name:KIRBY, LESLEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:KIRBY
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 1:522 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4428
Mailing Address - Country:US
Mailing Address - Phone:843-662-4327
Mailing Address - Fax:
Practice Address - Street 1:522 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4428
Practice Address - Country:US
Practice Address - Phone:843-662-4327
Practice Address - Fax:843-662-4395
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC865231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0019Medicaid
SCSA0019Medicaid