Provider Demographics
NPI:1770283681
Name:LEAR, DESTINEE CHRISTINE (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:CHRISTINE
Last Name:LEAR
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-7453
Mailing Address - Country:US
Mailing Address - Phone:573-221-2111
Mailing Address - Fax:
Practice Address - Street 1:1221 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-4005
Practice Address - Country:US
Practice Address - Phone:573-221-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022047479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker