Basic Information
| Provider Information | |||||||||
| NPI: | 1184665291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEHMAN | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 N. MIDVALE BLVD. | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082389991 | ||||||||
| FaxNumber: | 6082381929 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 PRAIRIE ST. | ||||||||
| Address2: | |||||||||
| City: | PRAIRIE DU SAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083569055 | ||||||||
| FaxNumber: | 6083565447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 2009-057 | WI | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 2009-057 | WI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 39120100 | 05 | WI | MEDICAID |