Provider Demographics
NPI:1982702387
Name:LEE, AMANDA B (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CAMDEN LANE
Mailing Address - Street 2:
Mailing Address - City:PORT BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-639-0956
Mailing Address - Fax:
Practice Address - Street 1:3105 N WILKE RD
Practice Address - Street 2:SUITE H
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-255-8690
Practice Address - Fax:847-255-2260
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist