MEDICARE: JOHN E. LEONARD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY12821	CA

General Provider Information

NPI Number	:	1336226083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E. LEONARD PH.D.

Provider Business Mailing Address
First Line	:	2659 PORTAGE BAY E
Second Line	:	SUITE 204
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	530-756-6438
Fax Number	:	530-419-0774

Provider Business Practice Location Address
First Line	:	2659 PORTAGE BAY E
Second Line	:	SUITE 204
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	530-756-6438
Fax Number	:	530-419-0774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/08/2013

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