Healthcare Provider Details

I. General information

NPI: 1770622391
Provider Name (Legal Business Name): EVELYN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CEDAR ST
MERRILL WI
54452-1228
US

IV. Provider business mailing address

901 N 6TH ST
WAUSAU WI
54403-4718
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-5022
  • Fax: 888-778-6750
Mailing address:
  • Phone: 715-848-5022
  • Fax: 888-778-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3924
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: