Provider Demographics
NPI:1982809349
Name:LEONARD, JANE PHILLIPS (MED)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:PHILLIPS
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FINCH FARM RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-8892
Mailing Address - Country:US
Mailing Address - Phone:336-472-1030
Mailing Address - Fax:
Practice Address - Street 1:836 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7481
Practice Address - Country:US
Practice Address - Phone:336-687-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408965Medicaid