Provider Demographics
NPI:1265581490
Name:BAERWALD, LEE ROBERT (LPC LIC PROF COUNS)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:ROBERT
Last Name:BAERWALD
Suffix:
Gender:M
Credentials:LPC LIC PROF COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S WASHBURN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904
Mailing Address - Country:US
Mailing Address - Phone:920-232-1400
Mailing Address - Fax:920-232-1444
Practice Address - Street 1:515 S WASHBURN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904
Practice Address - Country:US
Practice Address - Phone:920-232-1400
Practice Address - Fax:920-232-1444
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional