Provider Demographics
NPI:1417542580
Name:LEATHERS, AILI (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:AILI
Middle Name:
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-1261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:IL
Practice Address - Zip Code:61491-1172
Practice Address - Country:US
Practice Address - Phone:309-695-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-20-113435OtherBEHAVIOR ANALYST CERTIFICATION BOARD