Provider Demographics
NPI:1750616322
Name:LANCE, ERIN REBECCA
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:REBECCA
Last Name:LANCE
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 1:2222 E BELLEVIEW PL
Mailing Address - Street 2:210
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4061
Mailing Address - Country:US
Mailing Address - Phone:414-803-0338
Mailing Address - Fax:
Practice Address - Street 1:2222 E BELLEVIEW PL
Practice Address - Street 2:210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4061
Practice Address - Country:US
Practice Address - Phone:414-803-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency