Individual
MISS LESLIE ANNE DESSOURCES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
307 BLOOMFIELD AVE, CALDWELL, NJ 07006-5164
(862) 621-9390
Mailing address
320 CLAREMONT AVE, MONTCLAIR, NJ 07042-2223
(845) 269-0646
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS01062800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41YS01062800
SPEECH LANGAUGE PATHOLOGIST LICENSE
NJ
Enumeration date
05/04/2021
Last updated
01/22/2025
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