Provider Demographics
NPI:1437356136
Name:LEE, TINA J (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 CANOGA AVE
Mailing Address - Street 2:APT 107
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6632
Mailing Address - Country:US
Mailing Address - Phone:818-943-7126
Mailing Address - Fax:
Practice Address - Street 1:5535 CANOGA AVE
Practice Address - Street 2:APT 107
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6632
Practice Address - Country:US
Practice Address - Phone:818-943-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist