Provider Demographics
NPI:1063091049
Name:LEONHARD, LEXIE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:LEXIE
Middle Name:
Last Name:LEONHARD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 SANDY ACRES DR
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3675
Mailing Address - Country:US
Mailing Address - Phone:715-497-2093
Mailing Address - Fax:
Practice Address - Street 1:4500 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5014
Practice Address - Country:US
Practice Address - Phone:715-544-6847
Practice Address - Fax:715-600-9046
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI422-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst