Provider Demographics
NPI:1124640578
Name:LAPPING-CARR, LEISZLE RAE (PHD)
Entity type:Individual
Prefix:
First Name:LEISZLE
Middle Name:RAE
Last Name:LAPPING-CARR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LEISZLE
Other - Middle Name:RAE
Other - Last Name:ZIEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2976
Mailing Address - Country:US
Mailing Address - Phone:312-695-5060
Mailing Address - Fax:312-695-5507
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1000
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2976
Practice Address - Country:US
Practice Address - Phone:312-695-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010311103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist