Provider Demographics
NPI:1710020086
Name:LEHMAN, KELLY MARIE (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N759 RABBIT RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-9546
Mailing Address - Country:US
Mailing Address - Phone:920-667-4410
Mailing Address - Fax:
Practice Address - Street 1:1800 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3727
Practice Address - Country:US
Practice Address - Phone:920-968-6359
Practice Address - Fax:920-725-2572
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1416-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42788200Medicaid
WI1416-154OtherTHERAPY LICENSE