Provider Demographics
NPI:1457430951
Name:LESLEY, MARIE G (M/S/CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:G
Last Name:LESLEY
Suffix:
Gender:F
Credentials:M/S/CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 MASTERS LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3583
Mailing Address - Country:US
Mailing Address - Phone:770-736-3404
Mailing Address - Fax:770-736-5693
Practice Address - Street 1:2386 CLOWER ST
Practice Address - Street 2:BUILD. E, SUITE 102
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6134
Practice Address - Country:US
Practice Address - Phone:779-985-9050
Practice Address - Fax:770-985-9223
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00552098BMedicaid