MEDICARE: MRS. CATHERINE C LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	252Y00000X	OTHER	IL	DEPARTMENT OF HUMAN SERVICES

General Provider Information

NPI Number	:	1467813923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE C LEE

Provider Business Mailing Address
First Line	:	1460 N SANDBURG TR
Second Line	:	APT 1802
City	:	CHICAGO
State	:	IL
Zip	:	60610-5564
Country	:	US
Telephone Number	:	312-266-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 N SANDBURG TER
Second Line	:	APT 1802
City	:	CHICAGO
State	:	IL
Zip	:	60610-8514
Country	:	US
Telephone Number	:	312-266-0785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/11/2016

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