Provider Demographics
NPI:1477054377
Name:BONEY, LEAH ANNETTE (MS, QMHP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ANNETTE
Last Name:BONEY
Suffix:
Gender:F
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 S RAVINIA AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5353
Mailing Address - Country:US
Mailing Address - Phone:708-518-0748
Mailing Address - Fax:
Practice Address - Street 1:612 S WESTERN AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4682
Practice Address - Country:US
Practice Address - Phone:331-330-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health