Individual
DIOGENES LESLIE PERERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8801 N UNIVERSITY ST, PEORIA, IL 61615-1635
(309) 676-0538
Mailing address
8801 N UNIVERSITY ST, PEORIA, IL 61615-1635
(309) 676-0538
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
IL
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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