Provider Demographics
NPI:1740557628
Name:PRADO, LESLIE ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PRADO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4497
Mailing Address - Country:US
Mailing Address - Phone:956-457-6221
Mailing Address - Fax:
Practice Address - Street 1:2115 W PIKE BLVD
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-0054
Practice Address - Country:US
Practice Address - Phone:957-377-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist