MEDICARE: MRS. JESSICA CAROLINE LEE M.S. CCC-SLP

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	1428	AR

General Provider Information

NPI Number	:	1447337191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA CAROLINE LEE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 255
Second Line	:
City	:	CHOCTAW
State	:	AR
Zip	:	72028-0255
Country	:	US
Telephone Number	:	501-745-6606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 WALKER STREET
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031
Country	:	US
Telephone Number	:	501-745-6046
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. JESSICA CAROLINE LEE M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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