Provider Demographics
NPI:1154845048
Name:DURBIN, LESLIE RITA (CLC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RITA
Last Name:DURBIN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:GATEWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5324
Mailing Address - Country:US
Mailing Address - Phone:219-718-8883
Mailing Address - Fax:
Practice Address - Street 1:2750 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5324
Practice Address - Country:US
Practice Address - Phone:219-718-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
67018105A183700000X
ALPP-254322174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No183700000XPharmacy Service ProvidersPharmacy Technician