Provider Demographics
NPI:1033254347
Name:OAK LEYDEN DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:OAK LEYDEN DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HALLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:BILLER
Authorized Official - Phone:708-524-1050
Mailing Address - Street 1:411 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2233
Mailing Address - Country:US
Mailing Address - Phone:708-524-1050
Mailing Address - Fax:708-524-2469
Practice Address - Street 1:411 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2233
Practice Address - Country:US
Practice Address - Phone:708-524-1050
Practice Address - Fax:708-524-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171R00000X, 222Q00000X, 225A00000X, 104100000X, 225100000X, 225100000X, 225100000X, 225100000X, 225X00000X, 225X00000X, 235Z00000X, 235Z00000X, 235Z00000X, 235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618299Medicare UPIN