Healthcare Provider Details

I. General information

NPI: 1639000128
Provider Name (Legal Business Name): JACQUELINE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 HERITAGE WAY SE
ALBANY OR
97322-8600
US

IV. Provider business mailing address

2156 N HILL FIELD RD STE 3
LAYTON UT
84041-4780
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-8092
  • Fax: 541-967-7072
Mailing address:
  • Phone: 801-203-4055
  • Fax: 801-252-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number10252806
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: