Healthcare Provider Details

I. General information

NPI: 1447923701
Provider Name (Legal Business Name): LAURA LEDDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAIN ST STE 203
OSWEGO IL
60543-8593
US

IV. Provider business mailing address

515 MAJESTIC LN
OSWEGO IL
60543-4031
US

V. Phone/Fax

Practice location:
  • Phone: 630-733-9108
  • Fax:
Mailing address:
  • Phone: 630-544-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1619375078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: