Provider Demographics
NPI:1740594753
Name:LIEB, LESLEY LOU (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:LOU
Last Name:LIEB
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E 1100 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEMENT
Mailing Address - State:IL
Mailing Address - Zip Code:61813-3507
Mailing Address - Country:US
Mailing Address - Phone:217-520-4526
Mailing Address - Fax:
Practice Address - Street 1:1260 E 1100 NORTH RD
Practice Address - Street 2:
Practice Address - City:BEMENT
Practice Address - State:IL
Practice Address - Zip Code:61813-3507
Practice Address - Country:US
Practice Address - Phone:217-520-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist