Individual
JACK E LEAHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
311 W SUPERIOR ST STE 402, CHICAGO, IL 60654-3537
(630) 487-1801
Mailing address
311 W SUPERIOR ST STE 402, CHICAGO, IL 60654-3537
(312) 584-2144
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178018529
IL
Other
Enumeration date
11/11/2019
Last updated
03/09/2023
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