Healthcare Provider Details

I. General information

NPI: 1992366637
Provider Name (Legal Business Name): LEAH PAUL KAVANAGH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR STE 402
BIRMINGHAM AL
35205-1613
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 402
BIRMINGHAM AL
35205-1613
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9236
  • Fax: 205-918-1365
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-918-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1221A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1221A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: