Provider Demographics
NPI:1578248829
Name:WANCHEL-LEONARD, JODY B
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:B
Last Name:WANCHEL-LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2822
Mailing Address - Country:US
Mailing Address - Phone:516-567-8407
Mailing Address - Fax:
Practice Address - Street 1:41 BIRCH DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2822
Practice Address - Country:US
Practice Address - Phone:516-567-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist