Individual
MR. LESLIE JOEL ILLIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8530 S SAINT LAWRENCE AVE, CHICAGO, IL 60619-6025
(773) 852-0642
Mailing address
8530 S SAINT LAWRENCE AVE, CHICAGO, IL 60619-6025
(773) 852-0642
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150007727
IL
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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