Provider Demographics
NPI:1982805248
Name:SHAFTON, LESLIE H (PSYD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:H
Last Name:SHAFTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 OLD ORCHARD CENTER
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:312-208-0025
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD CENTER
Practice Address - Street 2:SUITE 607
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:312-208-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical