Provider Demographics
NPI:1326599630
Name:GREGORIN, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GREGORIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PYOTT RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-9794
Mailing Address - Country:US
Mailing Address - Phone:847-829-0922
Mailing Address - Fax:847-232-6526
Practice Address - Street 1:1301 PYOTT RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9794
Practice Address - Country:US
Practice Address - Phone:847-829-0922
Practice Address - Fax:847-232-6526
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist