Provider Demographics
NPI:1972860302
Name:GUIDOTTI BRETING, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:GUIDOTTI BRETING
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 1:909 DAVIS ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3683
Mailing Address - Country:US
Mailing Address - Phone:847-425-6433
Mailing Address - Fax:847-425-6408
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:SUITE 160
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3683
Practice Address - Country:US
Practice Address - Phone:847-425-6433
Practice Address - Fax:847-425-6408
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008242103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist