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General NPI Number Information
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NPI Number | 1346585155
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Entity Type | Individual
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Provider Name | CORINNE NICOLE LEONARD AU.D., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 4920 E STATE ST STE 6
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City | ROCKFORD
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State | IL
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Zip | 61108-2262
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Country | US
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Telephone | 779-423-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 2422 W MAIN ST UNIT 3A
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City | ST CHARLES
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State | IL
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Zip | 60175-1010
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Country | US
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Telephone | 630-402-2119
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Fax | 630-513-1980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147001430
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License Number State | IL
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