Provider Demographics
NPI:1891967725
Name:HART, ANN LESLIE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LESLIE
Last Name:HART
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624
Mailing Address - Country:US
Mailing Address - Phone:304-765-7005
Mailing Address - Fax:
Practice Address - Street 1:411 NORTH HILL ROAD
Practice Address - Street 2:BRAXTON COUNTY BOARD OF EDUCATION
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-765-7101
Practice Address - Fax:304-765-7148
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist