Provider Demographics
NPI:1902178213
Name:LEE, KATHLEEN JYONG (AUD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JYONG
Last Name:LEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:JYONG
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:10161 W. PARK RUN DR
Mailing Address - Street 2:STE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8872
Mailing Address - Country:US
Mailing Address - Phone:702-706-4358
Mailing Address - Fax:
Practice Address - Street 1:10161 W. PARK RUN DRIVE
Practice Address - Street 2:STE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8914
Practice Address - Country:US
Practice Address - Phone:702-706-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-165231H00000X
NV268237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist