Provider Demographics
NPI:1336483585
Name:LEENERTS, MICHELLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LEENERTS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 S 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3022
Mailing Address - Country:US
Mailing Address - Phone:402-715-1990
Mailing Address - Fax:402-715-1901
Practice Address - Street 1:5809 S 104TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3022
Practice Address - Country:US
Practice Address - Phone:402-715-1990
Practice Address - Fax:402-715-1901
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2017-08-31
Deactivation Date:2015-11-23
Deactivation Code:
Reactivation Date:2017-08-31
Provider Licenses
StateLicense IDTaxonomies
NE156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist