Healthcare Provider Details

I. General information

NPI: 1639304405
Provider Name (Legal Business Name): LESLIE LORRAINE HERR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD SUITE 6317
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

7300 WYNDHAM DR
SACRAMENTO CA
95823-4913
US

V. Phone/Fax

Practice location:
  • Phone: 623-760-6470
  • Fax:
Mailing address:
  • Phone: 623-760-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: