Provider Demographics
NPI:1851751655
Name:LEONARD, JACQUELINE C (CNS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:C
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-4260
Mailing Address - Fax:304-723-4264
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE C
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-4260
Practice Address - Fax:304-723-4264
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN58211CNS364SP0807X
OH289878364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent