Provider Demographics
NPI:1194477364
Name:CARTER, LEONARD A
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:A
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 AUSTIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2707
Mailing Address - Country:US
Mailing Address - Phone:224-636-3601
Mailing Address - Fax:
Practice Address - Street 1:1108 AUSTIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2707
Practice Address - Country:US
Practice Address - Phone:224-636-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor