Provider Demographics
NPI:1437206810
Name:LOS, LAVONNE LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:LEE
Last Name:LOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LAVONNE
Other - Middle Name:LEE
Other - Last Name:JANCHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:W155S7648 RAIN TREE CT
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-7762
Mailing Address - Country:US
Mailing Address - Phone:262-678-0487
Mailing Address - Fax:
Practice Address - Street 1:5407 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3715
Practice Address - Country:US
Practice Address - Phone:262-564-0067
Practice Address - Fax:262-652-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3822-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional