Provider Demographics
NPI:1235385139
Name:BENEDICT-LEE, MAUREEN
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:BENEDICT-LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 SE TAYLOR ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2678
Mailing Address - Country:US
Mailing Address - Phone:971-409-1058
Mailing Address - Fax:
Practice Address - Street 1:1636 SE TAYLOR ST
Practice Address - Street 2:APT. 5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2678
Practice Address - Country:US
Practice Address - Phone:971-409-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner