MEDICARE: TINA L LEKAS M.A.CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3880	OH

General Provider Information

NPI Number	:	1053439794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA L LEKAS M.A.CCC-SLP

Provider Business Mailing Address
First Line	:	6990 ENGLE RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3420
Country	:	US
Telephone Number	:	440-202-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	6990 ENGLE RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3420
Country	:	US
Telephone Number	:	440-202-4213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	10/24/2011

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