Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | IL | |
Y | 103T00000X | Psychologist | IL |
NPI | 1003970468 |
---|---|
Provider Name | Dr. Linda Leal |
First Address | Charleston, IL 61920-4330 |
Second Address | Charleston, IL 61920-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |