Healthcare Provider Details

I. General information

NPI: 1033274683
Provider Name (Legal Business Name): NICOLE M LEONARD AUD CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE M NIEHUES CCC-A

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD # MS 3010
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

12711 W 66TH ST
SHAWNEE KS
66216-2536
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6745
  • Fax: 913-588-4676
Mailing address:
  • Phone: 913-424-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2105
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: