Provider Demographics
NPI:1720671886
Name:THRONEBURG, LESLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:THRONEBURG
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 1:2301 KING JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7973
Mailing Address - Country:US
Mailing Address - Phone:630-730-1064
Mailing Address - Fax:
Practice Address - Street 1:511 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2152
Practice Address - Country:US
Practice Address - Phone:630-549-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149022682103TC2200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent