Provider Demographics
NPI:1093844524
Name:LEE, ELAINE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:SLP
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 284
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0284
Mailing Address - Country:US
Mailing Address - Phone:928-524-2123
Mailing Address - Fax:928-524-6367
Practice Address - Street 1:294 W CARLOS AVE
Practice Address - Street 2:NAVAJO COUNTY SPECIAL SERVICES CONSORTIUM
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-1846
Practice Address - Country:US
Practice Address - Phone:928-524-2123
Practice Address - Fax:928-524-6367
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist