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General NPI Number Information
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NPI Number | 1730042581
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Entity Type | Individual
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Provider Name | KYLA ANN-MARIE LEONARD PHD
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Gender |
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 608 RIDGEWOOD AVE APT 3
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3548
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Country | US
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Telephone | 630-715-0732
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Fax |
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Provider Business Mailing Address
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Address Line | 608 RIDGEWOOD AVE APT 3
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3548
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Country | US
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Telephone | 630-715-0732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | LP7241
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License Number State | MN
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