Healthcare Provider Details

I. General information

NPI: 1124772983
Provider Name (Legal Business Name): LESLIE C RUIZ M.S., SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 LEE DR
PONCHATOULA LA
70454-8123
US

IV. Provider business mailing address

823 LEE DR
PONCHATOULA LA
70454-8123
US

V. Phone/Fax

Practice location:
  • Phone: 504-330-3297
  • Fax:
Mailing address:
  • Phone: 504-330-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8274
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: