Provider Demographics
NPI:1114321668
Name:LEONARD, CHALON (HAD)
Entity Type:Individual
Prefix:MRS
First Name:CHALON
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MCNEAR CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5229
Mailing Address - Country:US
Mailing Address - Phone:707-338-1706
Mailing Address - Fax:
Practice Address - Street 1:52 MISSION CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5369
Practice Address - Country:US
Practice Address - Phone:707-538-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7901237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist