Healthcare Provider Details

I. General information

NPI: 1932836806
Provider Name (Legal Business Name): KRISTINA LOUISE LEUZZI CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEAR CORBITT RD
BEAR DE
19701-1323
US

IV. Provider business mailing address

3408 TREVI CT
PHILADELPHIA PA
19145-5758
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2400
  • Fax:
Mailing address:
  • Phone: 215-520-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01202400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL016322
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO1-0011986
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: