Provider Demographics
NPI:1801290275
Name:LAES, LEE ANN
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:LAES
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 1:681 BAETEN RD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-857-3056
Mailing Address - Fax:
Practice Address - Street 1:681 BAETEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4860
Practice Address - Country:US
Practice Address - Phone:920-857-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10590-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist