Healthcare Provider Details

I. General information

NPI: 1679409775
Provider Name (Legal Business Name): JEAN Y LEE, PSY D, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 ORRINGTON AVE STE 316
EVANSTON IL
60201-5060
US

IV. Provider business mailing address

1618 ORRINGTON AVE STE 316
EVANSTON IL
60201-5060
US

V. Phone/Fax

Practice location:
  • Phone: 847-347-9964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN LEE
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 847-347-9964