Provider Demographics
NPI:1912036328
Name:LEE, EVELYN MARGARET (MA)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MARGARET
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3502
Mailing Address - Country:US
Mailing Address - Phone:312-263-3925
Mailing Address - Fax:312-263-3925
Practice Address - Street 1:30 N MICHIGAN AVE STE 1001
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3502
Practice Address - Country:US
Practice Address - Phone:312-263-3925
Practice Address - Fax:312-263-3925
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001672303OtherBCBS OF ILLINOIS