Individual provider Active NPI

Leah Wondrak, SLP

  • Speech-Language Pathologist
  • Dixon, CA
National Provider Identifier
1417262262
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP28956 Issued in CA
Practice address
255 N Lincoln St Ste a
Dixon, CA 95620-3238
Phone
(707) 366-5247
NPI assigned
Aug 17, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP.9817 OH
Speech-Language Pathologist 235Z00000X SP28956 CA Primary

Addresses

Primary practice location

255 N Lincoln St Ste a
Dixon, CA 95620-3238

Mailing address

255 N Lincoln St Ste a
Dixon, CA 95620-3238
Phone (707) 366-5246

Other identifiers 1

IdentifierTypeStateIssuer
0028740MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260406001825 OH Practitioner - Qualified Speech Language Pathologist 7012482227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2500 Metrohealth Dr
Cleveland, OH 44109-1900

2500 Metrohealth Dr
Cleveland, OH 44109-1998

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SP28956CAMDSpeech-Language Pathologist
SP.9817OHMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Speech Therapy Consulting, Inc. Speech-Language Pathologist CurrentSince Apr 23, 2023 Accepting new patients

Locations

255 N Lincoln St
Ste A
Dixon, CA 95620
Phone (530) 591-3859

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1417262262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N LINCOLN ST STE A",
            "city": "DIXON",
            "state": "CA",
            "postal_code": "956203238",
            "telephone_number": "707-366-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N LINCOLN ST STE A",
            "city": "DIXON",
            "state": "CA",
            "postal_code": "956203238",
            "telephone_number": "707-366-5247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDRAK",
        "first_name": "LEAH",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-17",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP.9817",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP28956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028740",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dixon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.