Provider Demographics
NPI:1467813923
Name:LEE, CATHERINE C
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:C
Last Name: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 1:1460 N SANDBURG TR
Mailing Address - Street 2:APT 1802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5564
Mailing Address - Country:US
Mailing Address - Phone:312-266-0785
Mailing Address - Fax:
Practice Address - Street 1:1460 N SANDBURG TER
Practice Address - Street 2:APT 1802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8514
Practice Address - Country:US
Practice Address - Phone:312-266-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL252Y00000XOtherDEPARTMENT OF HUMAN SERVICES