Provider Demographics
NPI:1689659583
Name:LEE, KATHLEEN PATRICIA (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:ROMPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:6617 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1515
Mailing Address - Country:US
Mailing Address - Phone:219-845-7532
Mailing Address - Fax:
Practice Address - Street 1:7531 S STONY ISLAND AVE SUITE 155
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3913
Practice Address - Country:US
Practice Address - Phone:773-363-0188
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001570A231H00000X
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0167096524OtherBCBS
IL363290Medicare ID - Type Unspecified