Provider Demographics
NPI:1568779296
Name:LEE, SHAWNA SUE (AUD)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:SUE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6122
Mailing Address - Country:US
Mailing Address - Phone:715-717-6885
Mailing Address - Fax:175-717-6886
Practice Address - Street 1:900 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6122
Practice Address - Country:US
Practice Address - Phone:715-717-6885
Practice Address - Fax:175-717-6886
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI567-156231H00000X
CAAU2743231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist