Provider Demographics
NPI:1871477620
Name:LEANDER, AVORY JADE
Entity type:Individual
Prefix:
First Name:AVORY
Middle Name:JADE
Last Name:LEANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2429
Mailing Address - Country:US
Mailing Address - Phone:858-243-2131
Mailing Address - Fax:
Practice Address - Street 1:3303 MESA RIDGE RD APT 303
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6724
Practice Address - Country:US
Practice Address - Phone:760-452-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist