Healthcare Provider Details

I. General information

NPI: 1245193390
Provider Name (Legal Business Name): LEONA FATIMA LAVONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 FORTY FOOT RD
LANSDALE PA
19446
US

IV. Provider business mailing address

2319 CAROL LN
EAST NORRITON PA
19401-2046
US

V. Phone/Fax

Practice location:
  • Phone: 610-213-4809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL018939
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: