Individual
LEILANI R HERALY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3569
Mailing address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3569
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
15263-132
WI
Other
Enumeration date
12/22/2008
Last updated
12/22/2008
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