Basic Information
| Provider Information | |||||||||
| NPI: | 1003450339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUEGER | ||||||||
| FirstName: | LEIGH ANNE | ||||||||
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| OtherLastName: | BORG | ||||||||
| OtherFirstName: | LEIGH ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1301 E BIDWELL ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956303565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169835915 | ||||||||
| FaxNumber: | 9169835906 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E NATOMA ST | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956303383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163535295 | ||||||||
| FaxNumber: | 9169835906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2019 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP15043 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.