Provider Demographics
NPI:1609199272
Name:HALL, LESLIE A (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4070
Mailing Address - Country:US
Mailing Address - Phone:321-848-8544
Mailing Address - Fax:
Practice Address - Street 1:948 BRUNSWICK LN
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4070
Practice Address - Country:US
Practice Address - Phone:321-848-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst