Individual
MR. BOBBY JOE LEEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
808 S ELDORADO RD, SUITE 102, BLOOMINGTON, IL 61704-6071
(309) 310-4636
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 706-3190
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-013270
IL
Other
Enumeration date
02/08/2011
Last updated
02/08/2011
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