Provider Demographics
NPI:1952631335
Name:LEONG, ERIN MAIKO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MAIKO
Last Name:LEONG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DUNCAN WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1909
Mailing Address - Country:US
Mailing Address - Phone:510-206-3490
Mailing Address - Fax:
Practice Address - Street 1:7567 AMADOR VALLEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2441
Practice Address - Country:US
Practice Address - Phone:925-829-9555
Practice Address - Fax:707-215-6130
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist