| Lakeshore Psychology Services Llc | |
|
1045 W Glen Oaks Ln Ste 205 Mequon WI 53092 | |
| (414) 235-0431 | |
| Not Available |
| Full Name | Lakeshore Psychology Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1045 W Glen Oaks Ln Ste 205, Mequon, Wisconsin |
| Authorized Official Name and Position | Lee Edward Hildebrand (DIRECTOR) |
| Authorized Official Contact | 4142350431 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Psychology Services Llc 10123 N Lake Shore Dr Mequon WI 53092-6109 Ph: (414) 235-0431 | Lakeshore Psychology Services Llc 1045 W Glen Oaks Ln Ste 205 Mequon WI 53092 Ph: (414) 235-0431 |
| NPI Number | 1518459411 |
|---|---|
| Provider Enumeration Date | 06/06/2018 |
| Last Update Date | 06/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518459411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 3158-57 (Wisconsin) | Primary |
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