Healthcare Provider Details

I. General information

NPI: 1285207258
Provider Name (Legal Business Name): JANESSA M LEONARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST
INDIANAPOLIS IN
46204-1904
US

IV. Provider business mailing address

221 WATERFORD CT APT A
LAFAYETTE IN
47905-4586
US

V. Phone/Fax

Practice location:
  • Phone: 317-537-0987
  • Fax: 855-892-0299
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-533054
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: