Individual
DEWAYNE LEAKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
735 W 61ST ST, CHICAGO, IL 60621-2855
(773) 332-8381
Mailing address
735 W 61ST ST, CHICAGO, IL 60621-2855
(773) 332-8381
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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