Provider Information for 1942535968
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Ms. AUTUMN LEE DANTE LPC, NCC
Sex: Female
NPI: 1942535968
Last Updated: 2011-12-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1942535968 | ||||||||
| Enumeration Date | 2009-10-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2560 HEARTHSTONE DR OSHKOSH, WI 54901-1598 United States Phone: 920-379-6598 | Fax: | ||||||||
| Primary Practice Address | 627 BAY SHORE DR OSHKOSH, WI 54901-5228 United States Phone: 920-426-8988 | Fax: | ||||||||
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