Healthcare Provider Details

I. General information

NPI: 1851206684
Provider Name (Legal Business Name): LEAH WISARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE ST
OAK PARK IL
60301-1015
US

IV. Provider business mailing address

165 S OAK PARK AVE APT 15
OAK PARK IL
60302-2993
US

V. Phone/Fax

Practice location:
  • Phone: 708-620-2373
  • Fax:
Mailing address:
  • Phone: 614-307-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number20338
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: