Provider Demographics
NPI:1912366444
Name:LEONARD, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name: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 1:2688 CODY ESTEY RD
Mailing Address - Street 2:
Mailing Address - City:RHODES
Mailing Address - State:MI
Mailing Address - Zip Code:48652-9516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2688 CODY ESTEY RD
Practice Address - Street 2:
Practice Address - City:RHODES
Practice Address - State:MI
Practice Address - Zip Code:48652-9516
Practice Address - Country:US
Practice Address - Phone:989-701-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker