Provider Demographics
NPI:1528577418
Name:LEOMBRUNI, SUSAN LYNN (SLP)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:LYNN
Last Name:LEOMBRUNI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:SAICHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:305 HEEREN DR
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-9084
Mailing Address - Country:US
Mailing Address - Phone:815-988-7645
Mailing Address - Fax:
Practice Address - Street 1:520 N PIERPONT AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-5037
Practice Address - Country:US
Practice Address - Phone:815-966-3770
Practice Address - Fax:815-489-2689
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist