Provider Demographics
NPI:1366704207
Name:LEONARD, CHRISHELLE ANN (EDS)
Entity type:Individual
Prefix:
First Name:CHRISHELLE
Middle Name:ANN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2718
Mailing Address - Country:US
Mailing Address - Phone:716-662-6765
Mailing Address - Fax:
Practice Address - Street 1:2733 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7348
Practice Address - Country:US
Practice Address - Phone:716-631-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1278954103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool