Healthcare Provider Details

I. General information

NPI: 1205955242
Provider Name (Legal Business Name): CARLA LESLEY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 PIRATES POINT
CEDARVILLE AR
72932
US

IV. Provider business mailing address

4454 UNIONTOWN HWY
VAN BUREN AR
72956-8163
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-5073
  • Fax:
Mailing address:
  • Phone: 479-474-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number844
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: