Individual
TAWANA D LYONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2332 GILSON ST, RACINE, WI 53403-3010
(262) 800-1032
Mailing address
2332 GILSON ST, RACINE, WI 53403-3010
(262) 287-6222
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0018876
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002293446
IRS
WI
01
—
PROV0002293446
DHS
WI
Enumeration date
02/08/2023
Last updated
02/08/2023
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