Provider Demographics
NPI:1790106417
Name:SMITH, LESLIE (HAS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:DAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2232 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2158
Mailing Address - Country:US
Mailing Address - Phone:850-784-4327
Mailing Address - Fax:850-784-0060
Practice Address - Street 1:2232 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2158
Practice Address - Country:US
Practice Address - Phone:850-784-4327
Practice Address - Fax:850-784-0060
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4945237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist