MEDICARE: KRISTOPHER LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2018017877	MO

General Provider Information

NPI Number	:	1316545676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER LEE

Provider Business Mailing Address
First Line	:	470 FROG POND RD
Second Line	:
City	:	SEYMOUR
State	:	MO
Zip	:	65746-7296
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 E CLINTON AVE
Second Line	:
City	:	SEYMOUR
State	:	MO
Zip	:	65746-8938
Country	:	US
Telephone Number	:	417-935-2287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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Directions to “ KRISTOPHER LEE ” Practice Location

Language	Start Address	Practice Location

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