Provider Demographics
NPI:1639661689
Name:LEE, KIERSTAN ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIERSTAN
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2712
Mailing Address - Country:US
Mailing Address - Phone:904-583-2108
Mailing Address - Fax:
Practice Address - Street 1:211 W CHICAGO AVE STE 112
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3357
Practice Address - Country:US
Practice Address - Phone:630-455-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8202235Z00000X
FLSA16561235Z00000X
IL146.016854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist