Provider Demographics
NPI:1821354879
Name:LEESER, ANGELA CHRISTINE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:LEESER
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:P.O. BOX 511
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-0511
Mailing Address - Country:US
Mailing Address - Phone:773-616-4310
Mailing Address - Fax:866-209-6747
Practice Address - Street 1:1125 WESTER BLVD
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-2044
Practice Address - Country:US
Practice Address - Phone:773-616-4310
Practice Address - Fax:866-209-6747
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker