Provider Demographics
NPI:1225278179
Name:LEE, ADRIENNE D (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:D
Other - Last Name:FREIFELD-LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 GARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-447-0393
Mailing Address - Fax:
Practice Address - Street 1:170 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2233
Practice Address - Country:US
Practice Address - Phone:917-270-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist