Healthcare Provider Details

I. General information

NPI: 1245169382
Provider Name (Legal Business Name): MORGAN ALEXANDRA VAN LEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N DAMEN AVE
CHICAGO IL
60647-4565
US

IV. Provider business mailing address

4180 N MARINE DR APT 405
CHICAGO IL
60613-2207
US

V. Phone/Fax

Practice location:
  • Phone: 708-303-8688
  • Fax:
Mailing address:
  • Phone: 573-259-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071022640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: