Provider Demographics
NPI:1548728660
Name:LOPE, LESLIE A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:LOPE
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 1:2309 GILMER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2133
Mailing Address - Country:US
Mailing Address - Phone:318-423-1536
Mailing Address - Fax:903-470-7322
Practice Address - Street 1:2309 GILMER RD STE 101
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2133
Practice Address - Country:US
Practice Address - Phone:318-423-7536
Practice Address - Fax:903-470-7322
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115074235Z00000X
LA4083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist