Provider Demographics
NPI:1548420938
Name:SMITH, LESLEYE L (CCC-A)
Entity type:Individual
Prefix:
First Name:LESLEYE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3331
Mailing Address - Country:US
Mailing Address - Phone:601-835-0077
Mailing Address - Fax:601-835-0095
Practice Address - Street 1:201 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3331
Practice Address - Country:US
Practice Address - Phone:601-835-0077
Practice Address - Fax:601-835-0095
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2248231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist