Provider Demographics
NPI:1750418646
Name:FUNK, LEEANN JEANETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:JEANETTE
Last Name:FUNK
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:2161 NW MILITARY HWY
Mailing Address - Street 2:CMSE SUITE 308
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1878
Mailing Address - Country:US
Mailing Address - Phone:210-341-3336
Mailing Address - Fax:210-341-3455
Practice Address - Street 1:310 W LOSEY ST
Practice Address - Street 2:FAMILY ADVOCACY PROGRAM BUILDING 1533
Practice Address - City:SCOTT AIR FORCE BASE
Practice Address - State:IL
Practice Address - Zip Code:62225-5250
Practice Address - Country:US
Practice Address - Phone:618-256-7203
Practice Address - Fax:618-256-7246
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-06-16
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Provider Licenses
StateLicense IDTaxonomies
MO20010040591041C0700X
IL149.0094271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical