Provider Demographics
NPI:1821171745
Name:LEONARD, KATHLEEN RAE (MA, MAC, CADCIII)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RAE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA, MAC, CADCIII
Other - Prefix:MS
Other - First Name:KITTY
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4969 D ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6037
Mailing Address - Country:US
Mailing Address - Phone:541-741-6226
Mailing Address - Fax:541-682-2048
Practice Address - Street 1:135 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2618
Practice Address - Country:US
Practice Address - Phone:541-682-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR900108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)