Healthcare Provider Details

I. General information

NPI: 1306700679
Provider Name (Legal Business Name): LESLIE NICOLE SUELZER BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ATKINSON RD
GRAYSLAKE IL
60030-7801
US

IV. Provider business mailing address

1188 WINDEMERE CIR
GURNEE IL
60031-5196
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: