Provider Demographics
NPI:1275652315
Name:LEE, CORRIE RUTH (MSW, LCSW, SAC)
Entity Type:Individual
Prefix:MS
First Name:CORRIE
Middle Name:RUTH
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSW, SAC
Other - Prefix:MS
Other - First Name:CORRIE
Other - Middle Name:RUTH
Other - Last Name:LEOPOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3734 7TH AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5525
Mailing Address - Country:US
Mailing Address - Phone:262-654-0487
Mailing Address - Fax:262-654-2434
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-654-0487
Practice Address - Fax:262-654-2434
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14819-131101YA0400X
WI7331-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical