Provider Demographics
NPI:1598257123
Name:BANK, LESLIE LYNN
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNN
Last Name:BANK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-6228
Mailing Address - Country:US
Mailing Address - Phone:209-638-9752
Mailing Address - Fax:
Practice Address - Street 1:2056 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-6228
Practice Address - Country:US
Practice Address - Phone:209-638-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist