Provider Demographics
NPI:1912253824
Name:LEONARD, CAROL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-0484
Mailing Address - Country:US
Mailing Address - Phone:860-677-4048
Mailing Address - Fax:
Practice Address - Street 1:67 CHIPMAN DR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3102
Practice Address - Country:US
Practice Address - Phone:860-677-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002285235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist