# LEEP BEYOND NFP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174185672
- **Authorized official:** MRS. LORELL MARIN MST, MSW, DT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (773) 255-8155

## Contact information

- **Practice address:** 1280 W WASHINGTON BLVD, CHICAGO, IL 60607-1930
- **Practice address phone:** (312) 624-8750
- **Practice address fax:** (312) 624-8750
- **Mailing address:** 1280 W WASHINGTON BLVD, CHICAGO, IL 60607-1930
- **Mailing address phone:** (312) 624-8750
- **Mailing address fax:** (312) 624-8750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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