Provider Demographics
NPI:1215231618
Name:LEE, JANEANN (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JANEANN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-1901
Mailing Address - Country:US
Mailing Address - Phone:662-323-3684
Mailing Address - Fax:
Practice Address - Street 1:#4 PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-3684
Practice Address - Fax:662-323-3647
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2933231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04089015Medicaid