Provider Demographics
NPI:1306652730
Name:DUTTON, LESLIE RUTH (MS, CCC/SLP, PHD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:RUTH
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MS, CCC/SLP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 N BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1715
Mailing Address - Country:US
Mailing Address - Phone:806-544-8661
Mailing Address - Fax:
Practice Address - Street 1:10003 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2290
Practice Address - Country:US
Practice Address - Phone:806-544-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist