Healthcare Provider Details

I. General information

NPI: 1992572002
Provider Name (Legal Business Name): CARLEE ANNE LAKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 POE AVE STE 100
DAYTON OH
45414-2678
US

IV. Provider business mailing address

3903 WOODBINE AVE
DAYTON OH
45420-2552
US

V. Phone/Fax

Practice location:
  • Phone: 937-617-2273
  • Fax:
Mailing address:
  • Phone: 937-443-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: