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NPI Code Detail

MEDICARE: MR. CHRISTIAN LEDEZMA

MEDICARE: MR. CHRISTIAN LEDEZMA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1235644980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTIAN LEDEZMA
Provider Business Mailing Address
First Line : 917 OAKWOOD DR
Second Line :
City : ROUND LAKE BEACH
State : IL
Zip : 60073-1504
Country : US
Telephone Number : 224-308-8373
Fax Number :
Provider Business Practice Location Address
First Line : 1100 JORIE BLVD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-2219
Country : US
Telephone Number : 630-974-6602
Fax Number : 630-487-2411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2017
Last Update Date : 02/17/2025

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Directions to “ MR. CHRISTIAN LEDEZMA ” Practice Location

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