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NPI Code Detail

MEDICARE: CARLEE ANNE LAKES

MEDICARE: CARLEE ANNE LAKES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1992572002
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLEE ANNE LAKES
Provider Business Mailing Address
First Line : 3903 WOODBINE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-2552
Country : US
Telephone Number : 937-443-7319
Fax Number :
Provider Business Practice Location Address
First Line : 6640 POE AVE STE 100
Second Line :
City : DAYTON
State : OH
Zip : 45414-2678
Country : US
Telephone Number : 937-617-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2023
Last Update Date : 03/19/2026

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Directions to “ CARLEE ANNE LAKES ” Practice Location

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