MEDICARE: MRS. LESLIE A. HILBURN M.ED. SLP

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	SZ5029	FL

General Provider Information

NPI Number	:	1871893248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE A. HILBURN M.ED. SLP

Provider Business Mailing Address
First Line	:	875 LIMOUSIN LN
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-7834
Country	:	US
Telephone Number	:	478-456-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2286 WEDNESDAY ST
Second Line	:	SUITE 1
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8310
Country	:	US
Telephone Number	:	850-727-7928
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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