Healthcare Provider Details

I. General information

NPI: 1992642425
Provider Name (Legal Business Name): LEE ANDREW SIVELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 CARDINAL LN APT A
HOWARD WI
54313-7154
US

IV. Provider business mailing address

1270 CARDINAL LN APT A
HOWARD WI
54313-7154
US

V. Phone/Fax

Practice location:
  • Phone: 920-634-5074
  • Fax:
Mailing address:
  • Phone: 920-634-5074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: