Provider Demographics
NPI:1598986838
Name:FONTANA, LESLEY ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ELIZABETH
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:1515 JEFFERSON DAVIS HWY
Mailing Address - Street 2:APARTMENT 1110
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3314
Mailing Address - Country:US
Mailing Address - Phone:757-328-8229
Mailing Address - Fax:
Practice Address - Street 1:4560 SOUTH BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1160
Practice Address - Country:US
Practice Address - Phone:757-490-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2202004322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist