Provider Demographics
NPI:1164736484
Name:YEE, JENICA ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:ANN
Last Name:YEE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JENICA
Other - Middle Name:ANN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1764 MARCO POLO WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4503
Mailing Address - Country:US
Mailing Address - Phone:650-259-8535
Mailing Address - Fax:650-259-0188
Practice Address - Street 1:1764 MARCO POLO WAY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4503
Practice Address - Country:US
Practice Address - Phone:650-259-8535
Practice Address - Fax:650-259-0188
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001620235Z00000X
CA19201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist