Provider Demographics
NPI:1962630210
Name:KATES, LESLIE VICTOR (MED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:VICTOR
Last Name:KATES
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PENNIMAN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4136
Mailing Address - Country:US
Mailing Address - Phone:617-731-5551
Mailing Address - Fax:
Practice Address - Street 1:47 PENNIMAN RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4136
Practice Address - Country:US
Practice Address - Phone:617-731-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist