Provider Demographics
NPI:1023343142
Name:ZELINA, M. LEE (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:M. LEE
Middle Name:
Last Name:ZELINA
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:ZELINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5831 WINSLOW RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9642
Mailing Address - Country:US
Mailing Address - Phone:419-740-5630
Mailing Address - Fax:
Practice Address - Street 1:5831 WINSLOW RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9642
Practice Address - Country:US
Practice Address - Phone:419-740-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist