Provider Demographics
NPI:1700353505
Name:SCHWENDEMANN, LEE DEREK
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:DEREK
Last Name:SCHWENDEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N STOCKTON HILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4681
Mailing Address - Country:US
Mailing Address - Phone:702-417-4188
Mailing Address - Fax:928-529-5192
Practice Address - Street 1:2101 N STOCKTON HILL RD STE C
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4681
Practice Address - Country:US
Practice Address - Phone:702-417-4188
Practice Address - Fax:928-529-5192
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE5782237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist