Provider Demographics
NPI:1033274683
Name:LEONARD, NICOLE M (AUD CCC-A)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:LEONARD
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:NIEHUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A
Mailing Address - Street 1:12711 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2536
Mailing Address - Country:US
Mailing Address - Phone:913-424-2143
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 3010
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2937
Practice Address - Country:US
Practice Address - Phone:913-588-6745
Practice Address - Fax:913-588-4676
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2105231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200335290AMedicaid
KSQ51155Medicare UPIN