Provider Demographics
NPI:1699829879
Name:KLUESNER, LESLEY (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:KLUESNER
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 1:1461 BRAMBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1165
Mailing Address - Country:US
Mailing Address - Phone:575-270-1971
Mailing Address - Fax:
Practice Address - Street 1:1461 BRAMBLEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1165
Practice Address - Country:US
Practice Address - Phone:575-270-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist