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Organization
SPEECH THERAPY SERVICES
Active
Organization
SPEECH THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE C BLACK MS,CCC/SLP (SPEECH-LANGUAGE PATHOLOGIST)
(831) 204-1908
Entity
Organization
Contact information
Practice address
1421 WHISPERING PINES DR, SCOTTS VALLEY, CA 95066-4632
(209) 256-2742
Mailing address
2460 17TH AVE STE 1041, SANTA CRUZ, CA 95062-1860
(831) 204-1908
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
03/16/2022
Last updated
03/16/2022
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