1265490361 NPI number — MRS. LESLIE ANN THEYS MS CCC SLP

Table of content: (NPI 1447604137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265490361 NPI number — MRS. LESLIE ANN THEYS MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THEYS
Provider First Name:
LESLIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS 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:
HICKCOX
Provider Other First Name:
LESLIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSCCCSLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265490361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 LITTLE HORSE CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28657-9276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-915-1893
Provider Business Mailing Address Fax Number:
866-432-6140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 LITTLE HORSE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWLAND
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28657-9276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-915-1893
Provider Business Practice Location Address Fax Number:
866-432-6140
Provider Enumeration Date:
05/01/2006

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:  8539 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: NC8539 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7413265 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1171-154 . This is a "SPEECH AND LANGUAGE LICEN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 8539 . This is a "NC LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".