Provider Demographics
NPI:1093091597
Name:REED, LEESA K (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEESA
Middle Name:K
Last Name:REED
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 DELTA CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2975
Mailing Address - Country:US
Mailing Address - Phone:217-620-0373
Mailing Address - Fax:
Practice Address - Street 1:151 N. MAIN ST.
Practice Address - Street 2:HERITAGE BEHAVIORAL HEALTH
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523
Practice Address - Country:US
Practice Address - Phone:217-362-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490120841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical