Provider Demographics
NPI:1619403011
Name:DENNY, LEA SALOME (LPC-IT)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:SALOME
Last Name:DENNY
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70662
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-0662
Mailing Address - Country:US
Mailing Address - Phone:414-315-7271
Mailing Address - Fax:
Practice Address - Street 1:8626B W GREENFIELD AVE
Practice Address - Street 2:SUITE B300
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-315-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3414 - 226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health