Provider Demographics
NPI:1932238292
Name:DIRENZO, LESLIE (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DIRENZO
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ASH CT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7816
Mailing Address - Country:US
Mailing Address - Phone:412-860-1513
Mailing Address - Fax:
Practice Address - Street 1:1350 OLD FREEPORT RD
Practice Address - Street 2:SUITE 2AR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3122
Practice Address - Country:US
Practice Address - Phone:412-963-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist