Provider Demographics
NPI:1780634519
Name:GANT, LESLIE OSBORNE (AU D)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:OSBORNE
Last Name:GANT
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HAYWOOD PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-4404
Mailing Address - Country:US
Mailing Address - Phone:828-627-1950
Mailing Address - Fax:828-627-1070
Practice Address - Street 1:61 HAYWOOD PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-4404
Practice Address - Country:US
Practice Address - Phone:828-627-1950
Practice Address - Fax:828-627-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2059231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411092Medicaid
NC7001509Medicaid
NC7411092Medicaid