Healthcare Provider Details

I. General information

NPI: 1841302015
Provider Name (Legal Business Name): LESLIE ANNE TATUM MSCCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 CADENZA LN
DALLAS TX
75228-4923
US

IV. Provider business mailing address

2403 REBECCA DR
SACHSE TX
75048-4049
US

V. Phone/Fax

Practice location:
  • Phone: 214-328-4309
  • Fax: 214-328-4309
Mailing address:
  • Phone: 214-629-8685
  • Fax: 972-530-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: