Provider Demographics
NPI:1437239027
Name:GUM, LESLIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LYNN
Last Name:GUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 DRENDEL LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2341
Mailing Address - Country:US
Mailing Address - Phone:630-527-7033
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 138S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1244
Practice Address - Country:US
Practice Address - Phone:630-362-4445
Practice Address - Fax:630-528-3805
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490045191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13211Medicare ID - Type Unspecified