Provider Demographics
NPI:1831643774
Name:LEE, MARIAH MONIQUE (MA,CCC- SLP)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:MONIQUE
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 1:320 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3402
Mailing Address - Country:US
Mailing Address - Phone:937-496-6200
Mailing Address - Fax:
Practice Address - Street 1:2651 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2551
Practice Address - Country:US
Practice Address - Phone:135-363-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2017040-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist