Provider Demographics
NPI:1235945395
Name:LEONSTEIN, CARSON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:LEONSTEIN
Suffix:
Gender:M
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 1:14 KOGER RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4102
Mailing Address - Country:US
Mailing Address - Phone:203-917-0497
Mailing Address - Fax:
Practice Address - Street 1:14 KOGER RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4102
Practice Address - Country:US
Practice Address - Phone:203-917-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18.006822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist