Healthcare Provider Details

I. General information

NPI: 1558062422
Provider Name (Legal Business Name): NANCY LEON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 BEACONRIDGE DR
BOLINGBROOK IL
60440-2954
US

IV. Provider business mailing address

1952 MCDOWELL RD UNIT 305
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 847-921-6346
  • Fax:
Mailing address:
  • Phone: 630-689-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: