Healthcare Provider Details

I. General information

NPI: 1508414970
Provider Name (Legal Business Name): LESLIE WHITELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 E MAIN ST
SCOTTSDALE AZ
85251-4522
US

IV. Provider business mailing address

5335 E SHEA BLVD APT 2024
SCOTTSDALE AZ
85254-5734
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-6100
  • Fax:
Mailing address:
  • Phone: 480-776-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP11275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: