Provider Demographics
NPI:1639651441
Name:LEE, LORETTA BRYCE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:BRYCE
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 MARS DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3195
Mailing Address - Country:US
Mailing Address - Phone:254-420-5500
Mailing Address - Fax:254-420-0005
Practice Address - Street 1:8836 MARS DR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3195
Practice Address - Country:US
Practice Address - Phone:254-420-5500
Practice Address - Fax:254-420-0005
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist