Healthcare Provider Details

I. General information

NPI: 1982721015
Provider Name (Legal Business Name): LESLEY DOUMAUX MACCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 ROUTE 73 N STE 1
MARLTON NJ
08053-3456
US

IV. Provider business mailing address

751 ROUTE 73 N STE 1
MARLTON NJ
08053-3456
US

V. Phone/Fax

Practice location:
  • Phone: 856-375-2914
  • Fax:
Mailing address:
  • Phone: 856-375-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00488200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: