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General NPI Number Information
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NPI Number | 1457811655
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Entity Type | Individual
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Provider Name | TERRY ANN LEE M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 820 N 5TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1406
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Country | US
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Telephone | 913-684-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1963
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Country | US
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Telephone | 913-684-1400
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Fax | 913-684-1407
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2784
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License Number State | KS
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