=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508322140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN NEVADA SPEECH AND LANGUAGE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 02/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7582 LAS VEGAS BLVD S STE 143
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-670-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7582 LAS VEGAS BLVD S STE 143
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-670-0264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | LESLIE GIESLER
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 702-670-0264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------