Provider Demographics
NPI:1891848438
Name:MONTORO, LESLIE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MONTORO
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 NAUTICAL LN
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4448
Mailing Address - Country:US
Mailing Address - Phone:541-217-9142
Mailing Address - Fax:
Practice Address - Street 1:1197 NAUTICAL LN
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4448
Practice Address - Country:US
Practice Address - Phone:541-217-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist