Provider Demographics
NPI:1366903320
Name:CHAMBERS, LAWANDA
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:CHAMBERS
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:PO BOX 20709
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-0709
Mailing Address - Country:US
Mailing Address - Phone:920-815-6627
Mailing Address - Fax:
Practice Address - Street 1:9401 W BELOIT RD
Practice Address - Street 2:STE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4357
Practice Address - Country:US
Practice Address - Phone:414-573-0707
Practice Address - Fax:414-393-9773
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4652-226101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health