Provider Demographics
NPI:1245303262
Name:SLEA, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:SLEA
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 1:306 N 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3298
Mailing Address - Country:US
Mailing Address - Phone:641-792-4012
Mailing Address - Fax:641-791-0697
Practice Address - Street 1:306 N 3RD AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3298
Practice Address - Country:US
Practice Address - Phone:641-792-4012
Practice Address - Fax:641-791-0697
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)