Provider Demographics
NPI:1720249311
Name:LEONARD, J SANDRA
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:SANDRA
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 1:613 S TEBO ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1737
Mailing Address - Country:US
Mailing Address - Phone:660-647-2800
Mailing Address - Fax:660-647-5300
Practice Address - Street 1:613 S TEBO ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1737
Practice Address - Country:US
Practice Address - Phone:660-647-2800
Practice Address - Fax:660-647-5300
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical