Provider Demographics
NPI:1477011674
Name:STUBBS, LESLIE DANIELLE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DANIELLE
Last Name:STUBBS
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 1:7658 MORNING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3685
Mailing Address - Country:US
Mailing Address - Phone:702-275-4130
Mailing Address - Fax:
Practice Address - Street 1:7658 MORNING LAKE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3685
Practice Address - Country:US
Practice Address - Phone:702-275-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01072191OtherASHA
NVSP-1002OtherNV SPEECH AND HEARING