Provider Demographics
NPI:1619262771
Name:LEE, KRISTY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:ANN
Other - Last Name:RECTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1732 HERRIN ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2828
Mailing Address - Country:US
Mailing Address - Phone:602-538-1361
Mailing Address - Fax:
Practice Address - Street 1:1732 HERRIN ST
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2828
Practice Address - Country:US
Practice Address - Phone:602-538-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 5078235Z00000X
CASP 18956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist