Organization
LAKESHORE PSYCHOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE EDWARD HILDEBRAND PSYCHOLOGIST (DIRECTOR)
(414) 235-0431
Entity
Organization
Contact information
Practice address
1045 W GLEN OAKS LN STE 205, MEQUON, WI 53092
(414) 235-0431
Mailing address
10123 N LAKE SHORE DR, MEQUON, WI 53092-6109
(414) 235-0431
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3158-57
WI
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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