Provider Demographics
NPI:1275501025
Name:LEONARD, CHARLOTTE RANDOLPH (MS CCCA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RANDOLPH
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8037
Mailing Address - Country:US
Mailing Address - Phone:919-782-9003
Mailing Address - Fax:919-782-9303
Practice Address - Street 1:3820 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8037
Practice Address - Country:US
Practice Address - Phone:919-782-9003
Practice Address - Fax:919-782-9303
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2357231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001501Medicaid