Healthcare Provider Details

I. General information

NPI: 1750877866
Provider Name (Legal Business Name): TERI LEONHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERI GRISWOLD

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 E HERITAGE RD
FLORENCE AZ
85132-7200
US

IV. Provider business mailing address

6716 E HERITAGE RD
FLORENCE AZ
85132-7200
US

V. Phone/Fax

Practice location:
  • Phone: 480-825-4032
  • Fax: 480-452-1743
Mailing address:
  • Phone: 480-825-4032
  • Fax: 480-452-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57093
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: