Healthcare Provider Details

I. General information

NPI: 1679484695
Provider Name (Legal Business Name): LEAH LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH KORNATOWSKI

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CLAY BANK RD
FAIRFIELD CA
94533-1655
US

IV. Provider business mailing address

2460 CLAY BANK RD
FAIRFIELD CA
94533-1655
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4873
  • Fax:
Mailing address:
  • Phone: 707-399-4873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: