MEDICARE: MS. LESLEY DENISE LARIVE SPEECH LANGUAGE PATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1017	NE

General Provider Information

NPI Number	:	1003187139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLEY DENISE LARIVE SPEECH LANGUAGE PATH

Provider Business Mailing Address
First Line	:	5116 N 176TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3178
Country	:	US
Telephone Number	:	402-415-1682
Fax Number	:

Provider Business Practice Location Address
First Line	:	5116 N 176TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3178
Country	:	US
Telephone Number	:	402-415-1682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	04/03/2020

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Directions to “ MS. LESLEY DENISE LARIVE SPEECH LANGUAGE PATH” Practice Location

Language	Start Address	Practice Location

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