Provider Demographics
NPI:1043664360
Name:LEE, GRACE EUGENE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EUGENE
Last Name:LEE
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 1:8530 5TH AVE W
Mailing Address - Street 2:APT #A302
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7673
Mailing Address - Country:US
Mailing Address - Phone:253-905-3393
Mailing Address - Fax:
Practice Address - Street 1:14510 NE 20TH ST
Practice Address - Street 2:#203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3715
Practice Address - Country:US
Practice Address - Phone:206-218-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst