Provider Demographics
NPI:1982259313
Name:WEGNER, LESLIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:WEGNER
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 1:803 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5761
Mailing Address - Country:US
Mailing Address - Phone:214-205-8997
Mailing Address - Fax:
Practice Address - Street 1:803 KIPLING DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5761
Practice Address - Country:US
Practice Address - Phone:214-205-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist