MEDICARE: LESLIE MOORE HORN

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	SA11892	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215275714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MOORE HORN

Provider Business Mailing Address
First Line	:	153 PALM TREE CT
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7243
Country	:	US
Telephone Number	:	321-242-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 PALM TREE CT
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7243
Country	:	US
Telephone Number	:	321-242-3066
Fax Number	:

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

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/18/2013

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Directions to “ LESLIE MOORE HORN ” Practice Location

Language	Start Address	Practice Location

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