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General NPI Number Information
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NPI Number | 1164492567
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Entity Type | Individual
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Provider Name | MARCIALEE LEDBETTER MD
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 25 JUNE ST
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City | SANFORD
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State | ME
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Zip | 04073-2621
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Country | US
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Telephone | 207-324-4310
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Fax |
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Provider Business Mailing Address
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Address Line | 5148 N ASHLAND AVE # 1
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City | CHICAGO
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State | IL
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Zip | 60640-2830
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Country | US
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Telephone | 918-995-0584
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Fax | 918-660-3631
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036084346
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20207
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License Number State | OK
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