Provider Demographics
NPI:1659571875
Name:SEGAL, LESLEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VINEYARD
Other - Middle Name:
Other - Last Name:AUDIOLOGY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/A
Mailing Address - Street 1:PO BOX 2095
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0915
Mailing Address - Country:US
Mailing Address - Phone:508-696-4600
Mailing Address - Fax:508-696-3017
Practice Address - Street 1:20 INDIAN HILL ROAD
Practice Address - Street 2:
Practice Address - City:WEST TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02575
Practice Address - Country:US
Practice Address - Phone:508-696-4600
Practice Address - Fax:508-696-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA620231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASE013664Medicare UPIN