Provider Demographics
NPI:1710951322
Name:GIAMBRONE, LESLIE RICE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RICE
Last Name:GIAMBRONE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 BAY LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7187
Mailing Address - Country:US
Mailing Address - Phone:704-301-2683
Mailing Address - Fax:
Practice Address - Street 1:174 BAY LAUREL DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-7187
Practice Address - Country:US
Practice Address - Phone:704-301-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411622Medicaid