Provider Demographics
NPI:1508442278
Name:LEASK, ELLIE LEE (PA)
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:LEE
Last Name:LEASK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:LEE
Other - Last Name:HOOPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-4033
Mailing Address - Country:US
Mailing Address - Phone:715-209-4850
Mailing Address - Fax:
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3689
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5355-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant