Provider Demographics
NPI:1457141293
Name:MUDALLAL, LEEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEEN
Middle Name:
Last Name:MUDALLAL
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18153 PATRONELLA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3900
Mailing Address - Country:US
Mailing Address - Phone:310-819-0763
Mailing Address - Fax:
Practice Address - Street 1:24328 VERMONT AVE # 318
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2314
Practice Address - Country:US
Practice Address - Phone:424-250-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist