Healthcare Provider Details

I. General information

NPI: 1376314245
Provider Name (Legal Business Name): LESLEY DAWN BAUMGART SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEY DAWN FOX SLP

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W FAIDLEY AVE
GRAND ISLAND NE
68803-4109
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-5170
  • Fax: 308-398-5175
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2971
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: