Healthcare Provider Details

I. General information

NPI: 1720495476
Provider Name (Legal Business Name): HEATHER A. LEONARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 GREENWOOD AVE
WHEELING WV
26003-1449
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-231-6109
  • Fax:
Mailing address:
  • Phone: 304-233-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number471
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number471
License Number StateWV

VIII. Authorized Official

Name: HEATHER A LEONARD
Title or Position: OWNER
Credential: MS, RD CDE
Phone: 304-233-2455