Provider Demographics
NPI:1811703705
Name:GENEROLI, LEAH DEVINE (SLPA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DEVINE
Last Name:GENEROLI
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18435 SANTA ISADORA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5543
Mailing Address - Country:US
Mailing Address - Phone:714-864-7514
Mailing Address - Fax:
Practice Address - Street 1:800 S HARBOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5188
Practice Address - Country:US
Practice Address - Phone:657-208-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA90252355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant