Provider Demographics
NPI:1598131971
Name:DELEEUW, LUCY
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:DELEEUW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1677
Mailing Address - Country:US
Mailing Address - Phone:920-290-0107
Mailing Address - Fax:
Practice Address - Street 1:626 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-1547
Practice Address - Country:US
Practice Address - Phone:920-288-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1976-226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist