Healthcare Provider Details

I. General information

NPI: 1609097039
Provider Name (Legal Business Name): LESLIE S. MCCOLGIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6337 SHAW RD
MELBER KY
42069-8834
US

IV. Provider business mailing address

6337 SHAW RD
MELBER KY
42069-8834
US

V. Phone/Fax

Practice location:
  • Phone: 270-674-5654
  • Fax:
Mailing address:
  • Phone: 270-674-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0242
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: