Provider Demographics
NPI:1710154844
Name:ROUCO, LESLIE (SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ROUCO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2189
Mailing Address - Country:US
Mailing Address - Phone:786-431-5140
Mailing Address - Fax:305-827-0953
Practice Address - Street 1:5580 W 16TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2189
Practice Address - Country:US
Practice Address - Phone:786-431-5140
Practice Address - Fax:305-827-0953
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892896700Medicaid