Provider Demographics
NPI:1689639148
Name:WHITNEY, LESLI ANN (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:ANN
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:MISS
Other - First Name:LESLI
Other - Middle Name:ANN
Other - Last Name:MAYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:401 SOUTH 23RD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-935-1369
Mailing Address - Fax:
Practice Address - Street 1:1401 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-983-3092
Practice Address - Fax:765-983-3237
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003929A235Z00000X
OHSP77931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist