Healthcare Provider Details

I. General information

NPI: 1134942261
Provider Name (Legal Business Name): LEPTANDRUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23819 W MILL ST STE 109
PLAINFIELD IL
60544-3488
US

IV. Provider business mailing address

23819 W MILL ST STE 109
PLAINFIELD IL
60544-3488
US

V. Phone/Fax

Practice location:
  • Phone: 630-290-3013
  • Fax:
Mailing address:
  • Phone: 630-290-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. THOMAS S RYAN
Title or Position: THERAPIST
Credential: MS LCPC
Phone: 630-290-3013