Provider Demographics
NPI:1780852103
Name:ERICSSON, LESLEY J (AUD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:J
Last Name:ERICSSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 CATTLEMEN RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5033
Mailing Address - Country:US
Mailing Address - Phone:941-342-9228
Mailing Address - Fax:941-342-1301
Practice Address - Street 1:4046 CATTLEMEN RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5033
Practice Address - Country:US
Practice Address - Phone:941-342-9228
Practice Address - Fax:941-342-1301
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY147237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1401Medicare PIN