Provider Demographics
NPI:1588147219
Name:JANEZIC, LESLIE DIANE
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DIANE
Last Name:JANEZIC
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:DIANE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6560
Mailing Address - Country:US
Mailing Address - Phone:330-217-7134
Mailing Address - Fax:
Practice Address - Street 1:150 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3770
Practice Address - Country:US
Practice Address - Phone:330-606-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2018723-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist