Provider Demographics
NPI:1144565284
Name:GUMULAUSKAS, LEEANN ROCHELLE
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:ROCHELLE
Last Name:GUMULAUSKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:ROCHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S DEWEY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 S DEWEY ST STE 208
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3781
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4949-125101YP2500X
VA0701008515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional