Individual
MRS. LESLEE MICHELLE LASATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
29588 STATE HIGHWAY 51, WAGONER, OK 74467-8619
(918) 485-1522
Mailing address
29588 STATE HIGHWAY 51, WAGONER, OK 74467-8619
(918) 441-4157
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2169
OK
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100664140B
WAIVER CONTRACT FOR DDSD
OK
05
—
100664140C
—
OK
Enumeration date
10/16/2006
Last updated
10/14/2024
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