Provider Demographics
NPI:1154153831
Name:ABBOTT, LERAAEN WEY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LERAAEN
Middle Name:WEY
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 CENTRAL ST APT 218
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1531
Mailing Address - Country:US
Mailing Address - Phone:815-298-3890
Mailing Address - Fax:
Practice Address - Street 1:3201 OLD GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2999
Practice Address - Country:US
Practice Address - Phone:224-505-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.017814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist