Provider Demographics
NPI:1396916128
Name:PACKER, LESLIE (MS,CCC-A)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:PACKER
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9399 CROWN CREST BLVD 401
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8540
Mailing Address - Country:US
Mailing Address - Phone:720-274-2544
Mailing Address - Fax:720-274-2541
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:SUITE 431
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:720-274-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD94231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist