Provider Demographics
NPI:1003171950
Name:LEE, JOSEPHINE H (MA)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5055
Mailing Address - Country:US
Mailing Address - Phone:714-528-4405
Mailing Address - Fax:
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5055
Practice Address - Country:US
Practice Address - Phone:714-528-4405
Practice Address - Fax:714-528-8162
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 18812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist