Provider Demographics
NPI:1588218366
Name:LEE, SUE J (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2103
Mailing Address - Country:US
Mailing Address - Phone:808-727-5580
Mailing Address - Fax:
Practice Address - Street 1:355 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2103
Practice Address - Country:US
Practice Address - Phone:808-727-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12009434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist