MEDICARE: LESLIE HELLRUNG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	8095	KS
2	1041C0700X	Clinical Social Worker	2024040494	MO

General Provider Information

NPI Number	:	1881321099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE HELLRUNG LCSW

Provider Business Mailing Address
First Line	:	801 NW SAINT MARY DR STE 102
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2539
Country	:	US
Telephone Number	:	816-427-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 NW SAINT MARY DR STE 102
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2539
Country	:	US
Telephone Number	:	816-427-1337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2022
Last Update Date	:	10/16/2024

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