Provider Demographics
NPI:1922604339
Name:LEATHERMAN-KULIS, DAWN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LEATHERMAN-KULIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10741 S ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2115
Mailing Address - Country:US
Mailing Address - Phone:808-738-9463
Mailing Address - Fax:
Practice Address - Street 1:10439 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-3775
Practice Address - Country:US
Practice Address - Phone:773-234-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional