Leslie Ann Bacon
Individual provider Active NPI Speech-Language Pathologist · Saint Joseph, MO
NPI 1760159784 · NPPES record last updated Aug 26, 2021
Key facts
- NPI
- 1760159784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2020001770 (MO)
- Practice address
- 925 Felix St
Saint Joseph, MO 64501-2706 - Phone
- (816) 671-4000
- NPI assigned
- Aug 26, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020001770 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2020001770 | MO | Yes |
Addresses
Primary practice location
925 Felix St
Saint Joseph, MO 64501-2706
Mailing address
925 Felix St
Saint Joseph, MO 64501-2706
Phone (816) 671-4000
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All providers in Saint Joseph, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.