Provider Demographics
NPI:1679516512
Name:LEONARD, LISA JEAN (MA,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JEAN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3152
Mailing Address - Country:US
Mailing Address - Phone:719-660-4964
Mailing Address - Fax:719-219-6749
Practice Address - Street 1:6865 NOBLE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3152
Practice Address - Country:US
Practice Address - Phone:719-660-4964
Practice Address - Fax:719-219-6749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0175900235Z00000X
CO00932053 ASHA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20181787Medicaid