Provider Demographics
NPI:1366936353
Name:LEE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LEE
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 1:2086 AUTUMN HILL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2176
Mailing Address - Country:US
Mailing Address - Phone:734-604-2642
Mailing Address - Fax:
Practice Address - Street 1:2086 AUTUMN HILL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2176
Practice Address - Country:US
Practice Address - Phone:734-604-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-07-10
Deactivation Date:2018-06-22
Deactivation Code:
Reactivation Date:2018-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst