Provider Demographics
NPI:1770972770
Name:NASTASKIN, LESLIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:NASTASKIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1287
Mailing Address - Country:US
Mailing Address - Phone:267-880-6526
Mailing Address - Fax:
Practice Address - Street 1:3182 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1287
Practice Address - Country:US
Practice Address - Phone:267-880-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADONT HAVEMedicaid