Provider Demographics
NPI:1780842344
Name:LEONARD, MEYTAL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEYTAL
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 KANE CONCOURSE
Mailing Address - Street 2:402
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2053
Mailing Address - Country:US
Mailing Address - Phone:305-528-5851
Mailing Address - Fax:
Practice Address - Street 1:1160 KANE CONCOURSE
Practice Address - Street 2:402
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2053
Practice Address - Country:US
Practice Address - Phone:305-528-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 3847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist