Provider Demographics
NPI:1659412187
Name:MILLER, LESLIE WITHERS (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:WITHERS
Last Name:MILLER
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 1:2034 HOLLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2783
Mailing Address - Country:US
Mailing Address - Phone:704-867-2473
Mailing Address - Fax:
Practice Address - Street 1:2034 HOLLANDALE DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2783
Practice Address - Country:US
Practice Address - Phone:704-867-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist