Provider Demographics
NPI:1811147135
Name:MATTHEWS, LESLEY MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:MICHELLE
Last Name:MATTHEWS
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 1:3215 SHADE TREE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7832
Mailing Address - Country:US
Mailing Address - Phone:870-834-6369
Mailing Address - Fax:
Practice Address - Street 1:415 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6958
Practice Address - Country:US
Practice Address - Phone:870-612-1717
Practice Address - Fax:870-612-1719
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist