Provider Demographics
NPI:1912171794
Name:LEE, ASHLEY BROOK (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOK
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:BROOK
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:385 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2424
Mailing Address - Country:US
Mailing Address - Phone:847-487-2827
Mailing Address - Fax:
Practice Address - Street 1:385 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2424
Practice Address - Country:US
Practice Address - Phone:847-487-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005334213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist