Provider Demographics
NPI:1851699821
Name:LEASE, ILA SUE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ILA
Middle Name:SUE
Last Name:LEASE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8786
Mailing Address - Country:US
Mailing Address - Phone:610-366-0535
Mailing Address - Fax:
Practice Address - Street 1:1877 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8786
Practice Address - Country:US
Practice Address - Phone:610-366-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist