Provider Demographics
NPI:1295763548
Name:HUNTER-BLANK, ELIZABETH LEONA (LCSW,LSCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LEONA
Last Name:HUNTER-BLANK
Suffix:
Gender:F
Credentials:LCSW,LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1940
Mailing Address - Country:US
Mailing Address - Phone:816-582-3877
Mailing Address - Fax:913-362-5597
Practice Address - Street 1:4104 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2307
Practice Address - Country:US
Practice Address - Phone:816-582-3877
Practice Address - Fax:913-362-5597
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991353821041C0700X
KS20751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494763600Medicaid