Organization
RUSSELL LEANDER, LCPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL J LEANDER LCPC (OWNER)
(773) 807-7734
Entity
Organization
Contact information
Practice address
1631 W CARMEN AVE, CHICAGO, IL 60640-2701
(773) 807-7734
Mailing address
5115 N RAVENSWOOD AVE, CHICAGO, IL 60640-2712
(773) 807-7734
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
180-006834
IL
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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