NPI 1053731760

Russell Leander, Lcpc

Organisation Preferred Provider Organization Chicago, IL

Practice location

Address: 1631 W Carmen Ave, Chicago, IL 60640-2701
Phone: (773) 807-7734
Mailing address: 5115 N Ravenswood Ave, Chicago, IL 60640-2712

Authorised official

Name: Russell J Leander
Title: Owner
Phone: (773) 807-7734

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 180-006834 (IL)

Other Preferred Provider Organization providers in Illinois →

Registry record

NPI: 1053731760
Entity type: Organization
NPI issued: 21 Apr 2014
Record last updated: 21 Apr 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.