Individual
LESLIE CLARK LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
1140 W. SAVANNAH RIDGE ROAD, SUITE 111, HOLLY SPRINGS, NC 27540
(504) 356-3995
Mailing address
1140 W SAVANNAH RIDGE RD, SUITE 111, HOLLY SPRINGS, NC 27540
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11605
NC
235Z00000X
Speech-Language Pathologist
23594
CA
235Z00000X
Speech-Language Pathologist
3615
AL
235Z00000X
Speech-Language Pathologist
SLP008998
GA
Other
Enumeration date
12/15/2015
Last updated
10/17/2018
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