Provider Demographics
NPI:1497166011
Name:LEE, PENNY
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
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 1:3633 SE 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3370
Mailing Address - Country:US
Mailing Address - Phone:503-494-4222
Mailing Address - Fax:503-494-6143
Practice Address - Street 1:3633 SE 35TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3370
Practice Address - Country:US
Practice Address - Phone:503-494-4222
Practice Address - Fax:503-494-6143
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator