Provider Demographics
NPI:1821275181
Name:LEE, JENNIFER DUNCAN (MA, CCC-SLP, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DUNCAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANGEL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3167
Mailing Address - Country:US
Mailing Address - Phone:912-604-0186
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-330-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA432082052DMedicaid
1-12-10069OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC.