Active NPI
Lee Edward Hildebrand, PHD
- Psychologist
- Mequon, WI
National Provider Identifier
1487903597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3158-57
- Practice address
- 1045 W Glen Oaks LN Ste 205
Mequon, WI 53092 - Phone
- (414) 235-0431
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3158-57 | WI | Primary |
Addresses
Primary practice location
1045 W Glen Oaks LN Ste 205
Mequon, WI 53092
Mailing address
10123 N Lake Shore Dr
Mequon, WI 53092-6109
Phone (414) 235-0431
Other practice location 1
1009 W. Glen Oaks Lane, suite 209
Mequon, WI 53092
Phone (262) 240-0299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3158-57 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeshore Psychology Services LLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Mequon, WI
- NPI 1518459411
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1487903597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10123 N LAKE SHORE DR",
"city": "MEQUON",
"state": "WI",
"postal_code": "530926109",
"telephone_number": "414-235-0431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 W GLEN OAKS LN STE 205",
"city": "MEQUON",
"state": "WI",
"postal_code": "53092",
"telephone_number": "414-235-0431"
}
],
"practiceLocations": [
{
"address_1": "1009 W. Glen Oaks Lane, suite 209",
"address_purpose": "LOCATION",
"city": "Mequon",
"state": "WI",
"postal_code": "53092",
"country_code": "US",
"telephone_number": "262-240-0299",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HILDEBRAND",
"first_name": "LEE",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "3158-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.