Provider Demographics
NPI:1982052338
Name:CHAN, ALICE LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:LEE
Last Name:CHAN
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 1:23 CASSIDY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3537
Mailing Address - Country:US
Mailing Address - Phone:949-743-4513
Mailing Address - Fax:939-336-8125
Practice Address - Street 1:23 CASSIDY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3537
Practice Address - Country:US
Practice Address - Phone:949-743-4513
Practice Address - Fax:939-336-8125
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist