Provider Demographics
NPI:1699000554
Name:FLANAGAN, LISA NANCY DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:NANCY DAWN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3714
Mailing Address - Country:US
Mailing Address - Phone:309-660-6827
Mailing Address - Fax:
Practice Address - Street 1:103 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3714
Practice Address - Country:US
Practice Address - Phone:309-660-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490137881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical