Provider Demographics
NPI:1841688025
Name:THOLEN, LESLIE (SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:THOLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:MCCUTCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8769 S KELLIANN WAY
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8906
Mailing Address - Country:US
Mailing Address - Phone:620-532-9208
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE E230
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2818
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:785-587-1828
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201153290AMedicaid