MEDICARE: MS. LESLIE K PRUYN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1821086372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE K PRUYN MA

Provider Business Mailing Address
First Line	:	1444 N FARNSWORTH AVE
Second Line	:	#109
City	:	AURORA
State	:	IL
Zip	:	60505-1640
Country	:	US
Telephone Number	:	630-202-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 N FARNSWORTH AVE
Second Line	:	#109
City	:	AURORA
State	:	IL
Zip	:	60505-1640
Country	:	US
Telephone Number	:	630-202-3062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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