Individual provider Active NPI

Anna Christine Leis, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Fairfield, CA
National Provider Identifier
1356615744
Registry record updated Mar 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
18515 Issued in CA
Practice address
1125 Missouri St Ste 304a
Fairfield, CA 94533-6064
Phone
(925) 672-9440
NPI assigned
Mar 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 18515 CA Primary

Addresses

Primary practice location

1125 Missouri St Ste 304a
Fairfield, CA 94533-6064

Mailing address

2752 Hillview Dr
Fairfield, CA 94534-1078
Phone (310) 728-9298

Other names 1

  • Ms. Anna Christine Cordero Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
18515CAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330646400000",
    "number": "1356615744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2752 HILLVIEW DR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945341078",
            "telephone_number": "310-728-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 MISSOURI ST STE 304A",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945336064",
            "telephone_number": "925-672-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEIS",
        "first_name": "ANNA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-02",
        "last_updated": "2012-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "18515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "CORDERO",
            "middle_name": "CHRISTINE",
            "prefix": "MS.",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.