Healthcare Provider Details

I. General information

NPI: 1336779271
Provider Name (Legal Business Name): LEE VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 EDINA INDUSTRIAL BLVD STE 236
EDINA MN
55439-3066
US

IV. Provider business mailing address

5100 EDINA INDUSTRIAL BLVD STE 236
MINNEAPOLIS MN
55439-3066
US

V. Phone/Fax

Practice location:
  • Phone: 612-402-0852
  • Fax:
Mailing address:
  • Phone: 612-402-0852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: