Provider Demographics
NPI:1881820405
Name:LEEDIE, DAWN MARIE (LPCP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:LEEDIE
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KAYS DR
Mailing Address - Street 2:STE B
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1979
Mailing Address - Country:US
Mailing Address - Phone:309-862-0064
Mailing Address - Fax:
Practice Address - Street 1:405 KAYS DR
Practice Address - Street 2:STE B
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1979
Practice Address - Country:US
Practice Address - Phone:309-862-0064
Practice Address - Fax:309-862-1542
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11049101YA0400X
AZLPC-11604101YP2500X
IL180007287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)