Provider Demographics
NPI:1639746605
Name:LEJA LESSLIE, ASHLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:LEJA LESSLIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SKOKIE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2818
Mailing Address - Country:US
Mailing Address - Phone:847-272-2484
Mailing Address - Fax:
Practice Address - Street 1:601 SKOKIE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2818
Practice Address - Country:US
Practice Address - Phone:315-406-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty