Provider Demographics
NPI:1679889463
Name:STELTZER, LESLEY
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:STELTZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:ME
Mailing Address - Zip Code:04419-3453
Mailing Address - Country:US
Mailing Address - Phone:207-848-5173
Mailing Address - Fax:207-848-5196
Practice Address - Street 1:44 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:ME
Practice Address - Zip Code:04419-3453
Practice Address - Country:US
Practice Address - Phone:207-848-5173
Practice Address - Fax:207-848-5196
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-20-125845106S00000X
MESP1672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician