Healthcare Provider Details

I. General information

NPI: 1215545546
Provider Name (Legal Business Name): LEANNE LIXFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STEWART AVE STE 310
GARDEN CITY NY
11530-4701
US

IV. Provider business mailing address

201 SOUTHAVEN AVE
MEDFORD NY
11763-4058
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-3036
  • Fax: 516-627-6741
Mailing address:
  • Phone: 631-312-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: