MEDICARE: LESLIE S. BASS

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	SA4225	FL

General Provider Information

NPI Number	:	1457493884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE S. BASS

Provider Business Mailing Address
First Line	:	4035 EL PRADO BLVD
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-6309
Country	:	US
Telephone Number	:	305-663-4853
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 EL PRADO BLVD
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-6309
Country	:	US
Telephone Number	:	305-663-4853
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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Directions to “ LESLIE S. BASS ” Practice Location

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