Provider Demographics
NPI:1447403993
Name:LESSARD, LAURIE ANN
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:LESSARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6109
Mailing Address - Country:US
Mailing Address - Phone:715-552-2430
Mailing Address - Fax:715-830-4098
Practice Address - Street 1:3136 CRAIG RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6109
Practice Address - Country:US
Practice Address - Phone:715-552-2430
Practice Address - Fax:715-830-4098
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1425-132101YA0400X
WI7143-135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7143-135OtherDRL LICENSES
WI1425-132OtherDRL LICENSES