Provider Demographics
NPI:1538871561
Name:CHANDLER LEDRAY, LCSW, PLLC
Entity type:Organization
Organization Name:CHANDLER LEDRAY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-227-6684
Mailing Address - Street 1:225 N GROVE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2042
Mailing Address - Country:US
Mailing Address - Phone:407-227-6684
Mailing Address - Fax:
Practice Address - Street 1:1024 NORTH BLVD STE 207
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1149
Practice Address - Country:US
Practice Address - Phone:708-792-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty