Basic Information
| Provider Information | |||||||||
| NPI: | 1205579992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | LEKESHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 CHERBOURG DR APT 1209 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761205024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4093500751 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4825 WELLESLEY AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761076148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177326608 | ||||||||
| FaxNumber: | 8177354118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2022 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 119203 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.