Provider Demographics
NPI:1124845946
Name:LEONCAVALLO, KAMRYN ROSINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:ROSINA
Last Name:LEONCAVALLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 4TH ST N APT 710
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1701
Mailing Address - Country:US
Mailing Address - Phone:571-263-0407
Mailing Address - Fax:
Practice Address - Street 1:4707 W GANDY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3310
Practice Address - Country:US
Practice Address - Phone:813-728-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ11658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist