Healthcare Provider Details

I. General information

NPI: 1962558130
Provider Name (Legal Business Name): LEONARD ISRAEL PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 KNOTTY WOOD LN
WELLINGTON FL
33414-7808
US

IV. Provider business mailing address

309 KNOTTY WOOD LN
WELLINGTON FL
33414-7808
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-1142
  • Fax: 561-795-2401
Mailing address:
  • Phone: 561-798-1142
  • Fax: 561-795-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA2046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: