Provider Demographics
NPI:1841321270
Name:HAMMOND, LESLIE JEAN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7160 TCHULAHOMA RD
Mailing Address - Street 2:BLDG. B SUITE 4
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9266
Mailing Address - Country:US
Mailing Address - Phone:662-349-2733
Mailing Address - Fax:662-536-1849
Practice Address - Street 1:7160 TCHULAHOMA RD
Practice Address - Street 2:BLDG. B SUITE 4
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9266
Practice Address - Country:US
Practice Address - Phone:662-349-2733
Practice Address - Fax:662-536-1849
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS2277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120197Medicaid