Provider Demographics
NPI:1144619008
Name:KING, LESLIANN (EDD)
Entity Type:Individual
Prefix:DR
First Name:LESLIANN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W STATE ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2080
Mailing Address - Country:US
Mailing Address - Phone:815-757-5943
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:815-757-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional