Individual
LESLIE K POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
PSYD, HSPP
Contact information
Practice address
2010 N DAMEN AVE UNIT F, CHICAGO, IL 60647-3286
(773) 887-6447
Mailing address
7230 OLCOTT AVE, HAMMOND, IN 46323-2044
(219) 616-3646
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.022302
IL
103TC0700X
Clinical Psychologist
20043979B
IN
Other
Enumeration date
08/13/2025
Last updated
08/13/2025
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