Provider Demographics
NPI:1366659401
Name:BONNIE M LEE & ASSOCIATES
Entity Type:Organization
Organization Name:BONNIE M LEE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:920-347-3502
Mailing Address - Street 1:2200 DICKINSON ROAD UNIT 4B
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-347-3502
Mailing Address - Fax:920-347-3501
Practice Address - Street 1:2200 DICKINSON ROAD
Practice Address - Street 2:UNIT 4B
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-347-3502
Practice Address - Fax:920-347-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2088251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health