Healthcare Provider Details

I. General information

NPI: 1649448465
Provider Name (Legal Business Name): DR. LEAH HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 BALLANTRAE WAY
FLOSSMOOR IL
60422-4316
US

IV. Provider business mailing address

3717 BALLANTRAE WAY
FLOSSMOOR IL
60422-4316
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: