Provider Demographics
NPI:1578967832
Name:WASHINGTON, LEE III (HIS)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:WASHINGTON
Suffix:III
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MOUNT ZION DR
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1713
Mailing Address - Country:US
Mailing Address - Phone:920-748-2366
Mailing Address - Fax:920-748-2443
Practice Address - Street 1:315 MOUNT ZION DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1713
Practice Address - Country:US
Practice Address - Phone:920-748-2366
Practice Address - Fax:920-748-2443
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist