Basic Information
| Provider Information | |||||||||
| NPI: | 1578966248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEUNG | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | N2950 STATE ROAD 67 | ||||||||
| Address2: | |||||||||
| City: | LAKE GENEVA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531472655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622454630 | ||||||||
| FaxNumber: | 2622452248 | ||||||||
| Practice Location | |||||||||
| Address1: | N2950 STATE ROAD 67 | ||||||||
| Address2: | |||||||||
| City: | LAKE GENEVA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531472655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622454630 | ||||||||
| FaxNumber: | 2622452248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2014 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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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 | 237600000X | DA9042 | AZ | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 627-156 | WI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.