Provider Demographics
NPI:1225271851
Name:LEE, LISA BROWN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BROWN
Last Name:LEE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 N MOHAWK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8971
Mailing Address - Country:US
Mailing Address - Phone:313-410-7321
Mailing Address - Fax:
Practice Address - Street 1:4866 W BALMORAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1504
Practice Address - Country:US
Practice Address - Phone:313-410-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8281235Z00000X
IL146.009748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist