MEDICARE: DR. CORINNE NICOLE LEONARD AU.D., CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	147001430	IL

General Provider Information

NPI Number	:	1346585155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORINNE NICOLE LEONARD AU.D., CCC-A

Provider Business Mailing Address
First Line	:	2422 W MAIN ST UNIT 3A
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1010
Country	:	US
Telephone Number	:	630-402-2119
Fax Number	:	630-513-1980

Provider Business Practice Location Address
First Line	:	4920 E STATE ST STE 6
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2262
Country	:	US
Telephone Number	:	779-423-6910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	01/22/2021

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