Provider Demographics
NPI:1770978173
Name:WINTER, LANA (SAC)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1610
Mailing Address - Country:US
Mailing Address - Phone:715-360-8264
Mailing Address - Fax:
Practice Address - Street 1:3144 VANZILE RD
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520
Practice Address - Country:US
Practice Address - Phone:725-478-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16124-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)