Provider Demographics
NPI:1568101137
Name:LEE, MICHELLE JENE (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JENE
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 BICKLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2602
Mailing Address - Country:US
Mailing Address - Phone:510-828-9455
Mailing Address - Fax:
Practice Address - Street 1:5105 BICKLEY CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2602
Practice Address - Country:US
Practice Address - Phone:510-828-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist