Provider Demographics
NPI:1912914680
Name:LEONARD, JEANETTE STONE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:STONE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CLINIC DRIVE
Mailing Address - Street 2:PURDUE UNIVERSITY
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907
Mailing Address - Country:US
Mailing Address - Phone:765-490-3435
Mailing Address - Fax:765-496-1227
Practice Address - Street 1:715 CLINIC DRIVE
Practice Address - Street 2:PURDUE UNIVERSITY
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907
Practice Address - Country:US
Practice Address - Phone:765-490-3435
Practice Address - Fax:765-496-1227
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23000978231H00000X
IN23000978A231H00000X, 235Z00000X
IN22000978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist