MEDICARE: LESLIE DANIELLE STUBBS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01072191	OTHER		ASHA
2	SP-1002	OTHER	NV	NV SPEECH AND HEARING

General Provider Information

NPI Number	:	1477011674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE DANIELLE STUBBS

Provider Business Mailing Address
First Line	:	7658 MORNING LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3685
Country	:	US
Telephone Number	:	702-275-4130
Fax Number	:

Provider Business Practice Location Address
First Line	:	7658 MORNING LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3685
Country	:	US
Telephone Number	:	702-275-4130
Fax Number	:

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

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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Directions to “ LESLIE DANIELLE STUBBS ” Practice Location

Language	Start Address	Practice Location

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