Provider Demographics
NPI:1154691988
Name:LEITHEISER, CANDACE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:MARIE
Last Name:LEITHEISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ASHLAND AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2259
Mailing Address - Country:US
Mailing Address - Phone:312-874-8198
Mailing Address - Fax:
Practice Address - Street 1:1200 N ASHLAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2259
Practice Address - Country:US
Practice Address - Phone:312-874-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490172571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical