MEDICARE: MRS. AMY S. LEE M.A., C.C.C.

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	13697	NC
2	235Z00000X	Speech-Language Pathologist	LL60502109	WA
3	235Z00000X	Speech-Language Pathologist	SP10057	CA
4	235Z00000X	Speech-Language Pathologist	6953	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457415226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY S. LEE M.A., C.C.C.

Provider Business Mailing Address
First Line	:	1980 BIDWELL AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-9645
Country	:	US
Telephone Number	:	530-879-9507
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 ROCHARD LN
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-5851
Country	:	US
Telephone Number	:	530-518-8248
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/01/2020

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