Provider Demographics
NPI:1982063376
Name:LEE, MARCHELLA MING
Entity Type:Individual
Prefix:MRS
First Name:MARCHELLA
Middle Name:MING
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4039
Mailing Address - Country:US
Mailing Address - Phone:617-792-7117
Mailing Address - Fax:
Practice Address - Street 1:421 OLD CONNECTICUT PATH
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-4039
Practice Address - Country:US
Practice Address - Phone:617-792-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12012710235Z00000X
MA5699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist