Provider Demographics
NPI:1154614188
Name:LEONARD, TIFFANY (MED)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 RED OAK LANE
Mailing Address - Street 2:APT 4
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484-3255
Mailing Address - Country:US
Mailing Address - Phone:708-675-9397
Mailing Address - Fax:
Practice Address - Street 1:731 RED OAK LN
Practice Address - Street 2:APT 4
Practice Address - City:UNIVERSITY PARK
Practice Address - State:IL
Practice Address - Zip Code:60484-2935
Practice Address - Country:US
Practice Address - Phone:708-675-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist