Provider Demographics
NPI:1629353891
Name:MOFLEH, LEYLA (SLP)
Entity Type:Individual
Prefix:
First Name:LEYLA
Middle Name:
Last Name:MOFLEH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LEYLA
Other - Middle Name:
Other - Last Name:LARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 HUEHL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2304
Mailing Address - Country:US
Mailing Address - Phone:847-715-9667
Mailing Address - Fax:
Practice Address - Street 1:440 HUEHL RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2304
Practice Address - Country:US
Practice Address - Phone:847-715-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist