Provider Demographics
NPI:1437527579
Name:LEE, CRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
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 1:311 SW 28TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2616
Mailing Address - Country:US
Mailing Address - Phone:786-246-7201
Mailing Address - Fax:
Practice Address - Street 1:1300 CORAL WAY
Practice Address - Street 2:SUITE # 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2934
Practice Address - Country:US
Practice Address - Phone:305-854-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist