Provider Demographics
NPI:1194233452
Name:CARREON, LESLIE DIANNA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANNA
Last Name:CARREON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N WOODLAWN BLVD APT 237
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2209
Mailing Address - Country:US
Mailing Address - Phone:619-600-9532
Mailing Address - Fax:
Practice Address - Street 1:1999 N AMIDON AVE STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2122
Practice Address - Country:US
Practice Address - Phone:316-768-6718
Practice Address - Fax:316-252-1255
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
KS5002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician