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General NPI Number Information
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NPI Number | 1700550498
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Entity Type | Individual
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Provider Name | NICOLE M LEE LSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2506 FIELDS SOUTH DR APT 304
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3715
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Country | US
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Telephone | 217-203-2008
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Fax | 844-412-7089
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Provider Business Mailing Address
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Address Line | PO BOX 162
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City | PAXTON
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State | IL
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Zip | 60957-0162
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Country | US
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Telephone | 217-379-4302
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Fax | 217-817-0379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150117089
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License Number State | IL
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