Provider Demographics
NPI:1205162831
Name:LEE, KATHLEEN C (MA, SLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:795 CALLE PORTILLA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-750-3792
Mailing Address - Fax:805-484-1961
Practice Address - Street 1:795 CALLE PORTILLA
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-750-3792
Practice Address - Fax:805-484-1961
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist