Provider Demographics
NPI:1386371177
Name:IBUADO, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:IBUADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 HARDWARE DR NE STE E-1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2023
Mailing Address - Country:US
Mailing Address - Phone:505-268-5933
Mailing Address - Fax:505-268-0184
Practice Address - Street 1:4811 HARDWARE DR NE STE E-1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2023
Practice Address - Country:US
Practice Address - Phone:505-268-5933
Practice Address - Fax:505-268-0184
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2025-0022235Z00000X
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist