Provider Demographics
NPI:1750704649
Name:LEE, EUNSEY (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:EUNSEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
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 1:4526 220TH PL
Mailing Address - Street 2:FL 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3647
Mailing Address - Country:US
Mailing Address - Phone:646-852-8958
Mailing Address - Fax:
Practice Address - Street 1:236 2ND AVENUE, SUITE 401
Practice Address - Street 2:FUNCTIONAL LIFE ACHEIVEMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:646-852-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0233331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist