1275671240 NPI number — LESLIE LINDSAY AYLOR M.ED., CCC SLP

Table of content: LESLIE LINDSAY AYLOR M.ED., CCC SLP (NPI 1275671240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275671240 NPI number — LESLIE LINDSAY AYLOR M.ED., CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYLOR
Provider First Name:
LESLIE
Provider Middle Name:
LINDSAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTACOLA
Provider Other First Name:
LESLIE
Provider Other Middle Name:
LINDSAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275671240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10410 NEW CHAPEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOUT SPRING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24593-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-547-7757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 LOLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAVISTA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-369-6651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2204 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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