Provider Demographics
NPI:1013144310
Name:LEONARD, MARY C (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KINMAN
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 4177
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4177
Mailing Address - Country:US
Mailing Address - Phone:910-295-2609
Mailing Address - Fax:910-295-0026
Practice Address - Street 1:300 AMERICAN LEGION LN
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8978
Practice Address - Country:US
Practice Address - Phone:910-295-2609
Practice Address - Fax:910-295-0026
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist