Provider Demographics
NPI:1124565486
Name:LEE-ZIDEK, LAURIE ANN HST
Entity Type:Individual
Prefix:
First Name:LAURIE ANN
Middle Name:HST
Last Name:LEE-ZIDEK
Suffix:
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 1:45-775 APUAKEA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1710
Mailing Address - Country:US
Mailing Address - Phone:808-888-6570
Mailing Address - Fax:
Practice Address - Street 1:46-022 ALALOA ST STE 214
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3820
Practice Address - Country:US
Practice Address - Phone:808-330-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health