Provider Demographics
NPI:1871893248
Name:HILBURN, LESLIE A (MED SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:HILBURN
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:N
Other - Last Name:AVANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED SLP
Mailing Address - Street 1:875 LIMOUSIN LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7834
Mailing Address - Country:US
Mailing Address - Phone:478-456-1440
Mailing Address - Fax:
Practice Address - Street 1:2286 WEDNESDAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8310
Practice Address - Country:US
Practice Address - Phone:850-727-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist