Provider Demographics
NPI:1417509217
Name:GINGERY, LEE ANN (T-LMSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:GINGERY
Suffix:
Gender:F
Credentials:T-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0543
Mailing Address - Country:US
Mailing Address - Phone:620-688-1559
Mailing Address - Fax:
Practice Address - Street 1:116 1/2 WEST MYRTLE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301
Practice Address - Country:US
Practice Address - Phone:620-577-2700
Practice Address - Fax:620-331-0786
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11317104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker