Healthcare Provider Details

I. General information

NPI: 1952672354
Provider Name (Legal Business Name): LEEP FORWARD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 W MONTROSE AVE
CHICAGO IL
60613-1348
US

IV. Provider business mailing address

1447 W MONTROSE AVE
CHICAGO IL
60613-1348
US

V. Phone/Fax

Practice location:
  • Phone: 312-624-8750
  • Fax:
Mailing address:
  • Phone: 312-624-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORELL MARIN
Title or Position: CVO/OWNER
Credential: M.ED., LCSW, BCBA
Phone: 312-624-8750