Provider Demographics
NPI:1548348501
Name:WIDMER, LESLEY J (LCPC)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:J
Last Name:WIDMER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 BARNEY DR STE A4
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5260
Mailing Address - Country:US
Mailing Address - Phone:708-769-5347
Mailing Address - Fax:
Practice Address - Street 1:288 BARNEY DR STE A4
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5260
Practice Address - Country:US
Practice Address - Phone:708-769-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180004633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health