Provider Demographics
NPI:1528205820
Name:ERDOS, LEIGH (IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:
Last Name:ERDOS
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 N LEAMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3815
Mailing Address - Country:US
Mailing Address - Phone:773-329-1846
Mailing Address - Fax:773-282-5436
Practice Address - Street 1:4730 N LEAMINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3815
Practice Address - Country:US
Practice Address - Phone:773-329-1846
Practice Address - Fax:773-282-5436
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
108-42775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist