Provider Demographics
NPI:1881321099
Name:HELLRUNG, LESLIE (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HELLRUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 NW SAINT MARY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2539
Mailing Address - Country:US
Mailing Address - Phone:816-427-1337
Mailing Address - Fax:
Practice Address - Street 1:801 NW SAINT MARY DR STE 102
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2539
Practice Address - Country:US
Practice Address - Phone:816-427-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8095104100000X
MO20240404941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker