Provider Demographics
NPI:1184761306
Name:LEONARDI, LISA (MA, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LEONARDI
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RAMITA LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1918
Mailing Address - Country:US
Mailing Address - Phone:631-858-1860
Mailing Address - Fax:
Practice Address - Street 1:50 RAMITA LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1918
Practice Address - Country:US
Practice Address - Phone:631-858-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009916-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist