Provider Demographics
NPI:1174939573
Name:FRIEDLAND, LEAH (ATC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:FRIEDLAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:TANEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4239 N BLOOMINGTON AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-8311
Mailing Address - Country:US
Mailing Address - Phone:240-994-5937
Mailing Address - Fax:
Practice Address - Street 1:355 W SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3172
Practice Address - Country:US
Practice Address - Phone:630-617-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960034022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer