Provider Demographics
NPI:1457106072
Name:WARREN, LEE ANN NICOLE
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:NICOLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:NICOLE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5259 W JACKSON BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4335
Mailing Address - Country:US
Mailing Address - Phone:312-890-0199
Mailing Address - Fax:
Practice Address - Street 1:5259 W JACKSON BLVD APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4335
Practice Address - Country:US
Practice Address - Phone:312-890-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician