Provider Demographics
NPI:1962154781
Name:WHITEMAN, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W DIVERSEY PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1682
Mailing Address - Country:US
Mailing Address - Phone:773-217-0053
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:917-363-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2023-10-14
Deactivation Date:2023-06-21
Deactivation Code:
Reactivation Date:2023-09-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist