Provider Demographics
NPI:1134219165
Name:LEONARD, ANNE CECILE (MA, LP)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:CECILE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WILSON AVE NE
Mailing Address - Street 2:SUITE NUMBER 110
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-0440
Mailing Address - Country:US
Mailing Address - Phone:320-251-7700
Mailing Address - Fax:320-251-8898
Practice Address - Street 1:22 WILSON AVE NE
Practice Address - Street 2:SUITE NUMBER 110
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0440
Practice Address - Country:US
Practice Address - Phone:320-251-7700
Practice Address - Fax:320-251-8898
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0564103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist