Provider Demographics
NPI:1801820709
Name:LEONARD, JENIFER N (AUD CCC A)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:N
Last Name:LEONARD
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-686-3189
Mailing Address - Fax:863-682-1348
Practice Address - Street 1:710 E BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-686-3189
Practice Address - Fax:863-682-1348
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06582OtherHEAR USA
11982001OtherCITRUS HEALTHCARE
FL52937OtherBLUE CROSS BLUE SHIELD
FL190026OtherAMERIGROUP