Provider Demographics
NPI:1679653968
Name:LEE, ALICE W (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:W
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:W
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4302 N SEASONS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6445
Mailing Address - Country:US
Mailing Address - Phone:301-802-4474
Mailing Address - Fax:801-492-5080
Practice Address - Street 1:4302 N SEASONS VIEW DR
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6445
Practice Address - Country:US
Practice Address - Phone:301-802-4474
Practice Address - Fax:801-492-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225390-12052084P0800X
MDD00412952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF87252Medicare UPIN