Basic Information
Provider Information
NPI: 1033556915
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KORZUN
FirstName: LEAH
MiddleName: R
NamePrefix: MRS.
NameSuffix:  
Credential: M.S. CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WITKOV
OtherFirstName: LEAH
OtherMiddleName: R
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: M.S. CC-SLP
OtherLastNameType: 1
Mailing Information
Address1: 6719 MEADOWCREST DR
Address2:  
City: DOWNERS GROVE
State: IL
PostalCode: 605163526
CountryCode: US
TelephoneNumber: 6305420213
FaxNumber:  
Practice Location
Address1: 333 N PARK RD
Address2:  
City: LA GRANGE PARK
State: IL
PostalCode: 605261802
CountryCode: US
TelephoneNumber: 7084822400
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2013
LastUpdateDate: 11/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X242002290ILY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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