Provider Demographics
NPI:1396864856
Name:LEONARD, KERRY ELLEN (LPT, CPRP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ELLEN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LPT, CPRP
Other - Prefix:MISS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:KILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:2677 ZOE AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-3699
Mailing Address - Country:US
Mailing Address - Phone:310-772-9738
Mailing Address - Fax:
Practice Address - Street 1:2677 ZOE AVE STE 304
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-3699
Practice Address - Country:US
Practice Address - Phone:310-772-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPBGQWKMOZRYCHFE175T00000X
CANA225400000X
CAPT30252167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner