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General NPI Number Information
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NPI Number | 1174754972
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Entity Type | Organization
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Legal Business Name | PAMELA J LEONHARDT PSYD PLLC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 4076 DRIVER CT
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City | LONGMONT
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State | CO
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Zip | 80503-8314
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Country | US
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Telephone | 303-746-1160
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Fax |
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Provider Business Mailing Address
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Address Line | 4076 DRIVER CT
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City | LONGMONT
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State | CO
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Zip | 80503-8314
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Country | US
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Telephone | 303-746-1160
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAMELA J LEONHARDT
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Credential | PSYD
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Telephone | 303-746-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1992
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License Number State | CO
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