Provider Demographics
NPI:1316933252
Name:LOISEAU, LESLY (AUD)
Entity type:Individual
Prefix:DR
First Name:LESLY
Middle Name:
Last Name:LOISEAU
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 5TH AVE
Mailing Address - Street 2:DMOB SUITE 112
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-835-5111
Mailing Address - Fax:
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:DMOB SUITE 112
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-835-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002435231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9050709Medicaid
WA7132756Medicaid
WA9050709Medicaid
WA7132756Medicaid