Provider Demographics
NPI:1922269752
Name:LEE, NEDRA MARIE
Entity Type:Individual
Prefix:MRS
First Name:NEDRA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NEDRA
Other - Middle Name:MARIE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 TAMARIND LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1555
Mailing Address - Country:US
Mailing Address - Phone:708-335-4557
Mailing Address - Fax:773-471-5284
Practice Address - Street 1:3626 TAMARIND LN
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1555
Practice Address - Country:US
Practice Address - Phone:708-335-4557
Practice Address - Fax:773-471-5284
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist