Basic Information
| Provider Information | |||||||||
| NPI: | 1548728660 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPE | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 SHILOH RD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039392800 | ||||||||
| FaxNumber: | 8663864531 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 SHILOH RD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039392800 | ||||||||
| FaxNumber: | 8663864531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2019 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 115074 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.