Provider Demographics
NPI:1245812312
Name:COBB, LESLEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 RESERVOIR WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6786
Mailing Address - Country:US
Mailing Address - Phone:601-716-4032
Mailing Address - Fax:
Practice Address - Street 1:1220 APPLE PARK PL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3056
Practice Address - Country:US
Practice Address - Phone:601-825-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSSLP-4790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist