Provider Demographics
NPI:1912397092
Name:SWENSON, LEAH (LCPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC, ATR
Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8731
Mailing Address - Country:US
Mailing Address - Phone:815-676-4688
Mailing Address - Fax:815-676-4498
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:SUITE 204A
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8731
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:815-676-4498
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional