Healthcare Provider Details

I. General information

NPI: 1912553017
Provider Name (Legal Business Name): COURTNEY LEADBEATER AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EVERETT RD
ALBANY NY
12205-1407
US

IV. Provider business mailing address

123 EVERETT RD
ALBANY NY
12205-1407
US

V. Phone/Fax

Practice location:
  • Phone: 518-701-2000
  • Fax: 518-701-2139
Mailing address:
  • Phone: 518-701-2000
  • Fax: 518-701-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002886-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: