Provider Demographics
NPI:1811266968
Name:GARCIA, LEDEIDRE S
Entity type:Individual
Prefix:MS
First Name:LEDEIDRE
Middle Name:S
Last Name:GARCIA
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 1:4500 SATELLITE BLVD
Mailing Address - Street 2:STE 2290
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5037
Mailing Address - Country:US
Mailing Address - Phone:800-381-2195
Mailing Address - Fax:888-381-0822
Practice Address - Street 1:2205 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3113
Practice Address - Country:US
Practice Address - Phone:575-386-4184
Practice Address - Fax:575-526-1568
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLPA0002342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant