Provider Demographics
NPI:1639265168
Name:ZIMMER, LESLIE DIANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DIANE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 SPENCER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1111
Mailing Address - Country:US
Mailing Address - Phone:718-543-7689
Mailing Address - Fax:
Practice Address - Street 1:6112 SPENCER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1111
Practice Address - Country:US
Practice Address - Phone:718-543-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist