Provider Demographics
NPI:1043794779
Name:LEFFLER, CAROL MARIE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MARIE
Last Name:LEFFLER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W 648 TRINITY LANE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5223
Mailing Address - Country:US
Mailing Address - Phone:630-661-7970
Mailing Address - Fax:
Practice Address - Street 1:29 W 648 TRINITY LANE
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185
Practice Address - Country:US
Practice Address - Phone:630-661-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.001030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist