Provider Demographics
NPI:1922214683
Name:BIRD, LESLIE CAROL (MA CCCA)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CAROL
Last Name:BIRD
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE
Mailing Address - Street 2:SUITE 204B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-373-9600
Mailing Address - Fax:336-373-9676
Practice Address - Street 1:1400 BATTLEGROUND AVE
Practice Address - Street 2:SUITE 204B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-373-9600
Practice Address - Fax:336-373-9676
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2249231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist