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Organization
LEEP BEYOND NFP
Active
Organization
LEEP BEYOND NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORELL MARIN MST, MSW, DT (EXECUTIVE DIRECTOR)
(773) 255-8155
Entity
Organization
Contact information
Practice address
1280 W WASHINGTON BLVD, CHICAGO, IL 60607-1930
(312) 624-8750
(312) 624-8750
Mailing address
1280 W WASHINGTON BLVD, CHICAGO, IL 60607-1930
(312) 624-8750
(312) 624-8750
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QP2000X
Physical Therapy Clinic/Center
—
NULL
261QX0100X
Occupational Medicine Clinic/Center
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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