Provider Demographics
NPI:1255502340
Name:LEE, SHARON ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0133
Mailing Address - Country:US
Mailing Address - Phone:541-992-3008
Mailing Address - Fax:
Practice Address - Street 1:7905 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368
Practice Address - Country:US
Practice Address - Phone:541-992-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical