Healthcare Provider Details

I. General information

NPI: 1336063312
Provider Name (Legal Business Name): LEAH CAROL SEGVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WARRENVILLE RD STE 212
DOWNERS GROVE IL
60515-1761
US

IV. Provider business mailing address

2600 WARRENVILLE RD STE 212
DOWNERS GROVE IL
60515-1761
US

V. Phone/Fax

Practice location:
  • Phone: 708-792-0162
  • Fax:
Mailing address:
  • Phone: 708-792-0162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: