Provider Demographics
NPI:1558598763
Name:TANENBAUM, LEE R (MA, CCC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:TANENBAUM
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2320
Mailing Address - Country:US
Mailing Address - Phone:770-831-2313
Mailing Address - Fax:770-831-2778
Practice Address - Street 1:3725 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE B-3
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2320
Practice Address - Country:US
Practice Address - Phone:770-831-2313
Practice Address - Fax:770-831-2778
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist