Provider Demographics
NPI:1184665291
Name:LEHMAN, KERRI MICHELE (PHD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:MICHELE
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N. MIDVALE BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-238-9991
Mailing Address - Fax:608-238-1929
Practice Address - Street 1:1190 PRAIRIE ST.
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578
Practice Address - Country:US
Practice Address - Phone:608-356-9055
Practice Address - Fax:608-356-5447
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2009-057103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39120100Medicaid
WIS44747Medicare UPIN
S44747Medicare UPIN
WI39120100Medicaid