Provider Demographics
NPI:1396506895
Name:FUTTERKNECHT, LESLEY JILL (MA SLP CCC)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:JILL
Last Name:FUTTERKNECHT
Suffix:
Gender:F
Credentials:MA SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E DOMINION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2756
Mailing Address - Country:US
Mailing Address - Phone:352-870-9743
Mailing Address - Fax:
Practice Address - Street 1:100 E DOMINION BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2756
Practice Address - Country:US
Practice Address - Phone:352-870-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.09628235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist