Healthcare Provider Details

I. General information

NPI: 1750299152
Provider Name (Legal Business Name): BETHANY LORRAINE LEONARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MONROE ST
MADISON WI
53711-2169
US

IV. Provider business mailing address

2846 BARLOW ST
MADISON WI
53705-3622
US

V. Phone/Fax

Practice location:
  • Phone: 608-301-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8483226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: