Provider Demographics
NPI:1417100165
Name:LEONARD, KATHLEEN HERBRICH (MA, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HERBRICH
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BONNIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4902
Mailing Address - Country:US
Mailing Address - Phone:917-613-9034
Mailing Address - Fax:
Practice Address - Street 1:7 BONNIEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4902
Practice Address - Country:US
Practice Address - Phone:917-613-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009605-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist