Provider Demographics
NPI:1669369773
Name:REAL, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:REAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 LEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6905
Mailing Address - Country:US
Mailing Address - Phone:901-801-3311
Mailing Address - Fax:
Practice Address - Street 1:6413 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8219
Practice Address - Country:US
Practice Address - Phone:901-690-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician