Provider Demographics
NPI:1235428160
Name:TEERLINK, LESLIE A (LPC, CSAC, MS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:TEERLINK
Suffix:
Gender:F
Credentials:LPC, CSAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:IL
Mailing Address - Zip Code:62613-7490
Mailing Address - Country:US
Mailing Address - Phone:217-388-5471
Mailing Address - Fax:
Practice Address - Street 1:13100 ACORN DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:IL
Practice Address - Zip Code:62613-7490
Practice Address - Country:US
Practice Address - Phone:217-388-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4557-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional