Provider Demographics
NPI:1104157809
Name:LEONARD, JANELLE TAYLOR (LMP, LMT)
Entity type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:TAYLOR
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1116
Mailing Address - Country:US
Mailing Address - Phone:206-788-6777
Mailing Address - Fax:206-299-2822
Practice Address - Street 1:3809 42ND AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1116
Practice Address - Country:US
Practice Address - Phone:206-788-6777
Practice Address - Fax:206-299-2822
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60023360225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist