Provider Demographics
NPI:1932770989
Name:EGEMO, LEE E (BS, ACT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:EGEMO
Suffix:
Gender:F
Credentials:BS, ACT
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:E
Other - Last Name:ESSINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1807 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1142
Mailing Address - Country:US
Mailing Address - Phone:605-347-3003
Mailing Address - Fax:605-347-3003
Practice Address - Street 1:1807 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1142
Practice Address - Country:US
Practice Address - Phone:605-347-3003
Practice Address - Fax:605-347-3003
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8481101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)