MEDICARE: LEE CHASSEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401013302	MI

General Provider Information

NPI Number	:	1871988758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE CHASSEE

Provider Business Mailing Address
First Line	:	PO BOX 1767
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49501-1767
Country	:	US
Telephone Number	:	616-953-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 CANAL AVE SW STE M
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2667
Country	:	US
Telephone Number	:	616-953-0721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	04/17/2015

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Directions to “ LEE CHASSEE ” Practice Location

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