MEDICARE: MS. ANGELA CHRISTINE LEESER MSW, 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	149.011504	IL

General Provider Information

NPI Number	:	1821354879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA CHRISTINE LEESER MSW, LCSW

Provider Business Mailing Address
First Line	:	P.O. BOX 511
Second Line	:
City	:	HAMPSHIRE
State	:	IL
Zip	:	60140-0511
Country	:	US
Telephone Number	:	773-616-4310
Fax Number	:	866-209-6747

Provider Business Practice Location Address
First Line	:	1125 WESTER BLVD
Second Line	:
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-2044
Country	:	US
Telephone Number	:	773-616-4310
Fax Number	:	866-209-6747

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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