Provider Demographics
NPI:1780791921
Name:DEMARS, LESLIE CAROL (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:CAROL
Last Name:DEMARS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3687
Mailing Address - Country:US
Mailing Address - Phone:864-801-1138
Mailing Address - Fax:
Practice Address - Street 1:15 LANDSTONE CT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-3687
Practice Address - Country:US
Practice Address - Phone:864-801-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0373Medicaid