Provider Demographics
NPI:1518008721
Name:LEE, LINDA (FOSTER PARENT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FOSTER PARENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9857 E WINDY PASS TRL
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-4950
Mailing Address - Country:US
Mailing Address - Phone:480-671-4553
Mailing Address - Fax:
Practice Address - Street 1:2702 N 3RD ST # 2000
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-279-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ995467Medicaid