Provider Demographics
NPI:1871832014
Name:MANAUTOU, LESLEY PATRICIA
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:PATRICIA
Last Name:MANAUTOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N EXPRESSWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6831
Mailing Address - Country:US
Mailing Address - Phone:956-554-7006
Mailing Address - Fax:
Practice Address - Street 1:835 N EXPRESSWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6831
Practice Address - Country:US
Practice Address - Phone:956-554-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4849OtherMEDICARE
TX169033101Medicaid