Provider Demographics
NPI:1124309083
Name:ALLAN, LESLIE M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:ALLAN
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 1:3893 ESTHER LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3740
Mailing Address - Country:US
Mailing Address - Phone:724-301-8299
Mailing Address - Fax:
Practice Address - Street 1:3893 ESTHER LN
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3740
Practice Address - Country:US
Practice Address - Phone:724-301-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist