MEDICARE: LESLIE TRIBON M.S., 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	S-4573	MS

General Provider Information

NPI Number	:	1538691332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE TRIBON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	13219 HUGH SEYMOUR LN
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2288
Country	:	US
Telephone Number	:	228-334-5035
Fax Number	:	844-270-2749

Provider Business Practice Location Address
First Line	:	13219 HUGH SEYMOUR LN
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2288
Country	:	US
Telephone Number	:	228-334-5035
Fax Number	:	844-270-2749

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	08/08/2024

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