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General NPI Number Information
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NPI Number | 1790946630
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Entity Type | Organization
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Legal Business Name | DLD CLINICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 445 W JACKSON AVE SUITE 205
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone | 630-768-9608
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Fax |
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Provider Business Mailing Address
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Address Line | 445 W JACKSON AVE SUITE 205
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City | NAPERVILLE
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State | IL
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Zip | 60540-5256
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | NEAL LEATHERMAN
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Credential | LCSW
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Telephone | 630-768-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007260
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149010693
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License Number State | IL
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