Provider Demographics
NPI:1306177696
Name:GRUNSPAN, ILENE BETH (LSCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:BETH
Last Name:GRUNSPAN
Suffix:
Gender:F
Credentials:LSCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12618 SLATER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4721
Mailing Address - Country:US
Mailing Address - Phone:913-832-0366
Mailing Address - Fax:913-342-0069
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1924
Practice Address - Country:US
Practice Address - Phone:913-832-0366
Practice Address - Fax:913-342-0066
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical