Provider Demographics
NPI:1114085529
Name:LEE, JUDITH KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:KAY
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 COSTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-351-3599
Mailing Address - Fax:
Practice Address - Street 1:1361 W FREMONT ST
Practice Address - Street 2:KNOX COUNTY HEALTH DEPARTMENT
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2436
Practice Address - Country:US
Practice Address - Phone:309-344-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0147911041C0700X
IA0078901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical