Provider Demographics
NPI:1649713249
Name:LEE, SYDNE (MS CCC SLP/L)
Entity type:Individual
Prefix:
First Name:SYDNE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS CCC SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 HANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2312
Mailing Address - Country:US
Mailing Address - Phone:617-997-1952
Mailing Address - Fax:
Practice Address - Street 1:3452 LAKE LYNDA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1430
Practice Address - Country:US
Practice Address - Phone:800-774-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist