Provider Demographics
NPI:1578866604
Name:LEBRON, OSCAR (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:LEBRON
Suffix:
Gender:M
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 1:3090 EAGLE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3161
Mailing Address - Country:US
Mailing Address - Phone:407-690-2003
Mailing Address - Fax:
Practice Address - Street 1:1800 N WABASH RD STE 202
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1300
Practice Address - Country:US
Practice Address - Phone:765-251-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist