Provider Demographics
NPI:1730473299
Name:LEONARDO, JESSICA MARIAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIAN
Last Name:LEONARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIAN
Other - Last Name:PROULX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 RIDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5927
Mailing Address - Country:US
Mailing Address - Phone:847-331-0878
Mailing Address - Fax:847-215-1437
Practice Address - Street 1:940 RIDGEFIELD LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5927
Practice Address - Country:US
Practice Address - Phone:847-331-0878
Practice Address - Fax:847-215-1437
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist