Provider Demographics
NPI:1073027652
Name:STRAUB, LEE ANN I
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:STRAUB
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 ROSCOMMON CT
Mailing Address - Street 2:
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265-9458
Mailing Address - Country:US
Mailing Address - Phone:517-467-9081
Mailing Address - Fax:
Practice Address - Street 1:805 S MAUMEE ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2053
Practice Address - Country:US
Practice Address - Phone:517-467-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010982011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical