Provider Demographics
NPI:1841258936
Name:TYLER, LESLIE MERIA (MSP, CCC - SLP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MERIA
Last Name:TYLER
Suffix:
Gender:F
Credentials:MSP, CCC - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 HARD SCRABBLE RD
Mailing Address - Street 2:APARTMENT 526
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9363
Mailing Address - Country:US
Mailing Address - Phone:803-699-1142
Mailing Address - Fax:
Practice Address - Street 1:4920 HARD SCRABBLE RD
Practice Address - Street 2:APARTMENT 526
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9363
Practice Address - Country:US
Practice Address - Phone:803-699-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3705235Z00000X
GASLP006190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0715Medicaid