Provider Demographics
NPI:1366846552
Name:HARLESS, LEIGH (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:
Last Name:HARLESS
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E LAKE COOK RD STE 1100
Mailing Address - Street 2:PRIMESOURCE HEALTHCARE SYSTEMS, INC
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1815
Mailing Address - Country:US
Mailing Address - Phone:847-267-8200
Mailing Address - Fax:877-821-6402
Practice Address - Street 1:2000 TOWN CENTER, STE 1900
Practice Address - Street 2:PRIMESOURCE OF MICHIGAN LLC
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000691231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist