Healthcare Provider Details

I. General information

NPI: 1326703679
Provider Name (Legal Business Name): LEAH ELIZABETH HASDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 ELM PL STE 110
HIGHLAND PARK IL
60035-3122
US

IV. Provider business mailing address

565 HOWARD ST
EVANSTON IL
60202-4014
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: