Healthcare Provider Details

I. General information

NPI: 1407711922
Provider Name (Legal Business Name): ELIZABETH LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SPRUCE ST N
CAMBRIDGE MN
55008-2908
US

IV. Provider business mailing address

815 SPRUCE ST N
CAMBRIDGE MN
55008-2908
US

V. Phone/Fax

Practice location:
  • Phone: 612-323-1198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: