Individual
LEISEL IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1641 N. MILKWAUKEE AVENUE, ADLER PARK PLAZA, SUITE 7, LIBERTYVILLE, IL 60048
(847) 362-6919
Mailing address
3025 N SEMINARY AVENUE, GDN, CHICAGO, IL 60657
(219) 682-4130
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
2255A2300X
Athletic Trainer
080502241
—
Other
Enumeration date
01/15/2022
Last updated
01/15/2022
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