Provider Demographics
NPI:1336311984
Name:AARON, LEE R (CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:R
Last Name:AARON
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1724
Mailing Address - Country:US
Mailing Address - Phone:215-492-1079
Mailing Address - Fax:215-492-1083
Practice Address - Street 1:7051 PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-1724
Practice Address - Country:US
Practice Address - Phone:215-492-1079
Practice Address - Fax:215-492-1083
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001002L171W00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019394390004Medicaid