Provider Demographics
NPI:1770905861
Name:HANAGAN, LESLIE RHEA (SLP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:RHEA
Last Name:HANAGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 SILTSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436
Mailing Address - Country:US
Mailing Address - Phone:770-548-2861
Mailing Address - Fax:
Practice Address - Street 1:255 N. LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620
Practice Address - Country:US
Practice Address - Phone:707-366-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21309235Z00000X
NVSP2498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist