Provider Demographics
NPI:1669006714
Name:LESSARD, RONALD DANIEL
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:DANIEL
Last Name:LESSARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E MONROE AVE FL CENTER3
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1479
Mailing Address - Country:US
Mailing Address - Phone:715-537-6382
Mailing Address - Fax:
Practice Address - Street 1:335 E MONROE AVE FL CENTER3
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1479
Practice Address - Country:US
Practice Address - Phone:715-537-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)