Healthcare Provider Details

I. General information

NPI: 1205210770
Provider Name (Legal Business Name): HOLLY LEONARD MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 WILLOW AVE
LA PUENTE CA
91746-1696
US

IV. Provider business mailing address

236 S LOS ANGELES ST APT 423
LOS ANGELES CA
90012-3782
US

V. Phone/Fax

Practice location:
  • Phone: 626-931-2943
  • Fax:
Mailing address:
  • Phone: 719-232-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number25969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: