Provider Demographics
NPI:1588932511
Name:COX, CONGER LESLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CONGER
Middle Name:LESLIE
Last Name:COX
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 CAPRICE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9159
Mailing Address - Country:US
Mailing Address - Phone:815-546-1175
Mailing Address - Fax:
Practice Address - Street 1:909 CAPRICE DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-9159
Practice Address - Country:US
Practice Address - Phone:815-546-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071 007771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical