Provider Demographics
NPI:1912281254
Name:LEE, LINDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65523
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0018
Mailing Address - Country:US
Mailing Address - Phone:360-334-6301
Mailing Address - Fax:360-334-6307
Practice Address - Street 1:13220 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2288
Practice Address - Country:US
Practice Address - Phone:360-334-6301
Practice Address - Fax:360-334-6307
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4165103TC0700X
MA9619103TC0700X
WAPY60234783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical