Provider Demographics
NPI:1932360377
Name:DOMMA, LESLIE SIMONEAUX (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SIMONEAUX
Last Name:DOMMA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7952 GOODWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7629
Mailing Address - Country:US
Mailing Address - Phone:225-972-7011
Mailing Address - Fax:225-927-7910
Practice Address - Street 1:7952 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7629
Practice Address - Country:US
Practice Address - Phone:225-972-7011
Practice Address - Fax:225-927-7910
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4136231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist