Provider Demographics
NPI:1255106191
Name:LEE, JOSHUA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 E LOOS ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2090
Mailing Address - Country:US
Mailing Address - Phone:262-206-6794
Mailing Address - Fax:
Practice Address - Street 1:874 E LOOS ST UNIT 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2090
Practice Address - Country:US
Practice Address - Phone:262-206-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist