Provider Demographics
NPI:1063885309
Name:LEONARD, LESLIE ANN (EDS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-1450
Mailing Address - Country:US
Mailing Address - Phone:740-498-8373
Mailing Address - Fax:
Practice Address - Street 1:702 S RIVER ST
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-1450
Practice Address - Country:US
Practice Address - Phone:740-498-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1232824103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool