MEDICARE: LESLIE LEACH CRAWFORD SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001632220	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1215084314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE LEACH CRAWFORD SLP

Provider Business Mailing Address
First Line	:	103 MARION RD
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2942
Country	:	US
Telephone Number	:	847-295-2963
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 MARION RD
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2942
Country	:	US
Telephone Number	:	847-295-2963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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Directions to “ LESLIE LEACH CRAWFORD SLP” Practice Location

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