Basic Information
| Provider Information | |||||||||
| NPI: | 1659893675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILNER | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | ANGELICA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 TURK ST APT 301 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941023834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136871701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14766 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945784220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103522211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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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 | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.