Healthcare Provider Details

I. General information

NPI: 1427294487
Provider Name (Legal Business Name): AYALA LEYSER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 W. ST PAUL AVE 4E
CHICAGO IL
60647
US

IV. Provider business mailing address

2251 W. ST PAUL AVE 4E
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-7422
  • Fax:
Mailing address:
  • Phone: 773-278-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180003862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: