Provider Demographics
NPI:1861731143
Name:CLOGSTON, LESLEY IRENE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:IRENE
Last Name:CLOGSTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LEE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9777
Mailing Address - Country:US
Mailing Address - Phone:413-478-6800
Mailing Address - Fax:
Practice Address - Street 1:110 LEE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9777
Practice Address - Country:US
Practice Address - Phone:413-478-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist