Provider Demographics
NPI:1609941897
Name:BREWER, LESLIE DIANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DIANE
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:DIANE
Other - Last Name:BORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:66 FOXHOUND RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-6613
Mailing Address - Country:US
Mailing Address - Phone:731-641-8881
Mailing Address - Fax:
Practice Address - Street 1:800 VOLUNTEER DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5472
Practice Address - Country:US
Practice Address - Phone:731-642-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist