Provider Demographics
NPI:1184141186
Name:JONES, LESLIE ANN (SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1S785 IRONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7397
Mailing Address - Country:US
Mailing Address - Phone:312-388-9623
Mailing Address - Fax:
Practice Address - Street 1:225 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5264
Practice Address - Country:US
Practice Address - Phone:630-200-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist