Provider Demographics
NPI:1285035295
Name:LEE, DANIELLE (MS, SAC, LPC-IT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, SAC, LPC-IT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 W HISTORIC MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3533
Mailing Address - Country:US
Mailing Address - Phone:414-316-5004
Mailing Address - Fax:414-671-6606
Practice Address - Street 1:930 W HISTORIC MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3533
Practice Address - Country:US
Practice Address - Phone:414-316-5004
Practice Address - Fax:414-671-6606
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2900-226101YP2500X
WI16108-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100058832Medicaid