Provider Demographics
NPI:1912124439
Name:SPENCER, LESLIE SUSANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUSANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS, 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:P. O. BOX 1256
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921
Mailing Address - Country:US
Mailing Address - Phone:479-632-0434
Mailing Address - Fax:
Practice Address - Street 1:508 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AR
Practice Address - Zip Code:72938
Practice Address - Country:US
Practice Address - Phone:479-639-2910
Practice Address - Fax:479-639-2158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist