Provider Demographics
NPI:1255507729
Name:LEON, CLARY M (ATOL)
Entity Type:Individual
Prefix:MISS
First Name:CLARY
Middle Name:M
Last Name:LEON
Suffix:
Gender:F
Credentials:ATOL
Other - Prefix:
Other - First Name:CLARY
Other - Middle Name:M
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THL
Mailing Address - Street 1:HC 2 BOX 3934
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-9867
Mailing Address - Country:US
Mailing Address - Phone:787-638-9734
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA # 3 INT 759 KM 2 HM 4 BARRIO LIZAS
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-638-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR689174400000X
PR10242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant