Healthcare Provider Details

I. General information

NPI: 1063730422
Provider Name (Legal Business Name): BETSY ANN LEONE M.S. CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 CRONRIDGE DR
OWINGS MILLS MD
21117-1434
US

IV. Provider business mailing address

5257 WENTZ RD
MANCHESTER MD
21102-1221
US

V. Phone/Fax

Practice location:
  • Phone: 410-517-1113
  • Fax:
Mailing address:
  • Phone: 716-680-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019985
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06850
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: