Provider Demographics
NPI:1912067174
Name:HINSHAW, LESLIE ERNEST (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ERNEST
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC
Mailing Address - Street 2:5015 PROSPECT AVE NE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4045
Mailing Address - Country:US
Mailing Address - Phone:505-764-0036
Mailing Address - Fax:505-764-0446
Practice Address - Street 1:ALBUQUERQUE AREA INDIAN HEALTH BOARD, INC
Practice Address - Street 2:5015 PROSPECT AVE NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4045
Practice Address - Country:US
Practice Address - Phone:505-764-0036
Practice Address - Fax:505-764-0446
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2451231H00000X
CO396231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K3526Medicaid
NMHSZ196OtherMEDICARE PART B
NMZ7095Medicaid
NM000K3526Medicaid