Provider Demographics
NPI:1104202159
Name:ENSWORTH, LEISA KATHLEEN (MA)
Entity type:Individual
Prefix:
First Name:LEISA
Middle Name:KATHLEEN
Last Name:ENSWORTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 WALKER ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1746
Mailing Address - Country:US
Mailing Address - Phone:714-523-4327
Mailing Address - Fax:
Practice Address - Street 1:7851 WALKER ST STE 206
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1746
Practice Address - Country:US
Practice Address - Phone:714-523-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1155231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist