Healthcare Provider Details

I. General information

NPI: 1972467256
Provider Name (Legal Business Name): DOMINIKA LANDAU-LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

895 SUMAC RD
HIGHLAND PARK IL
60035-3840
US

IV. Provider business mailing address

895 SUMAC RD
HIGHLAND PARK IL
60035-3840
US

V. Phone/Fax

Practice location:
  • Phone: 872-265-1840
  • Fax:
Mailing address:
  • Phone: 872-265-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: