Provider Demographics
NPI:1346585155
Name:LEONARD, CORINNE NICOLE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:NICOLE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 W MAIN ST UNIT 3A
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1010
Mailing Address - Country:US
Mailing Address - Phone:630-402-2119
Mailing Address - Fax:630-513-1980
Practice Address - Street 1:4920 E STATE ST STE 6
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2262
Practice Address - Country:US
Practice Address - Phone:779-423-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001430231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist