Provider Demographics
NPI:1730184011
Name:FRASER, LESLIE ANN (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:FRASER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10666 NE 11TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2123
Mailing Address - Country:US
Mailing Address - Phone:305-899-8892
Mailing Address - Fax:305-899-1137
Practice Address - Street 1:12340 NE 6TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5518
Practice Address - Country:US
Practice Address - Phone:305-981-4000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA0002406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA0002406OtherFL STATE SLP LICENSE