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NPI Code Detail

MEDICARE: SANDRA LYNN LEAHY AUD

MEDICARE: SANDRA LYNN LEAHY AUD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist1601000288MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11601000288OTHERMILICENSE

General Provider Information

NPI Number : 1962542530
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LYNN LEAHY AUD
Provider Business Mailing Address
First Line : 3241 RACQUET CLUB DR
Second Line : SUITE B
City : TRAVERSE CITY
State : MI
Zip : 49684-4708
Country : US
Telephone Number : 231-922-1500
Fax Number : 231-922-1502
Provider Business Practice Location Address
First Line : 3241 RACQUET CLUB DR
Second Line : SUITE B
City : TRAVERSE CITY
State : MI
Zip : 49684-4708
Country : US
Telephone Number : 231-922-1500
Fax Number : 231-922-1502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 11/13/2012

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