Basic Information
| Provider Information | |||||||||
| NPI: | 1811266968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | LEDEIDRE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 SATELLITE BLVD | ||||||||
| Address2: | STE 2290 | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300965037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003812195 | ||||||||
| FaxNumber: | 8883810822 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 S MAIN ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753864184 | ||||||||
| FaxNumber: | 5755261568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2011 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SLPA000234 | GA | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.