Provider Demographics
NPI:1699155135
Name:BROWN, LESLIE ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-0038
Mailing Address - Country:US
Mailing Address - Phone:918-567-2259
Mailing Address - Fax:918-567-5344
Practice Address - Street 1:600 1ST ST
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2003
Practice Address - Country:US
Practice Address - Phone:918-567-2259
Practice Address - Fax:918-567-5344
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist