=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679722722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY LEES & ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2008
-----------------------------------------------------
Last Update Date | 09/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 SW 101ST AVE
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-261-3983
-----------------------------------------------------
Fax | 954-476-0183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 SW 101ST AVE
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-261-3983
-----------------------------------------------------
Fax | 954-476-0183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH PATHOLOGIST
-----------------------------------------------------
Name | MRS. AMY ALEXANDRA LEES
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 954-261-3983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA 6360
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------