Provider Demographics
NPI:1215590096
Name:LEE, JAYLIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAYLIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 CAROL ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2202
Mailing Address - Country:US
Mailing Address - Phone:224-209-3990
Mailing Address - Fax:
Practice Address - Street 1:5057 CAROL ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2202
Practice Address - Country:US
Practice Address - Phone:224-209-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist