Healthcare Provider Details

I. General information

NPI: 1487088167
Provider Name (Legal Business Name): VICTORIA LEE M.S.ED, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0200
  • Fax: 718-815-2182
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: