Provider Demographics
NPI:1548579774
Name:RUNYAN, LEAH ALLISON (MS CFY SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ALLISON
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:MS CFY SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 EUCLID AVE
Mailing Address - Street 2:302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3265
Mailing Address - Country:US
Mailing Address - Phone:503-896-0479
Mailing Address - Fax:
Practice Address - Street 1:353 EUCLID AVE
Practice Address - Street 2:302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3265
Practice Address - Country:US
Practice Address - Phone:503-896-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist