Provider Demographics
NPI:1962799619
Name:WILSON, LESLIE ANN (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 E ALLEN ST APT 22
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7664
Mailing Address - Country:US
Mailing Address - Phone:720-272-0416
Mailing Address - Fax:
Practice Address - Street 1:391 E ALLEN ST APT 22
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7664
Practice Address - Country:US
Practice Address - Phone:720-272-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist