Provider Demographics
NPI:1588072581
Name:LEONARD, WENDY HACKLEMAN (RD)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:HACKLEMAN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:MICHELE
Other - Last Name:HACKLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:320 PHILLIPS ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5149
Mailing Address - Country:US
Mailing Address - Phone:401-398-2454
Mailing Address - Fax:401-633-6956
Practice Address - Street 1:320 PHILLIPS ST STE 203
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5149
Practice Address - Country:US
Practice Address - Phone:401-398-2454
Practice Address - Fax:401-633-6956
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
832374133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered