Individual
MS. VICKI LEE LAFOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1478 KENWOOD CTR, MENASHA, WI 54952-1161
(920) 886-9319
(920) 886-9357
Mailing address
3027 RIVERSIDE AVE, MARINETTE, WI 54143-1121
(715) 587-2763
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7227-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41002500
—
WI
Enumeration date
07/16/2006
Last updated
07/08/2007
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