Healthcare Provider Details

I. General information

NPI: 1336755016
Provider Name (Legal Business Name): CATHERINE LEE VANDER LEEK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE LEE MCCLAIN

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 N 59TH ST
MILWAUKEE WI
53210-2214
US

IV. Provider business mailing address

2354 N 59TH ST
MILWAUKEE WI
53210-2214
US

V. Phone/Fax

Practice location:
  • Phone: 630-818-6765
  • Fax:
Mailing address:
  • Phone: 630-818-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5479154
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14180124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: