Provider Demographics
NPI:1700550498
Name:LEE, NICOLE M (LSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-0162
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-817-0379
Practice Address - Street 1:2506 FIELDS SOUTH DR APT 304
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3715
Practice Address - Country:US
Practice Address - Phone:217-203-2008
Practice Address - Fax:844-412-7089
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150117089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker