MEDICARE: MS. DEBBIE LEE MS. 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	006365-1	NY

General Provider Information

NPI Number	:	1558516633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBBIE LEE MS. CCC-SLP

Provider Business Mailing Address
First Line	:	98 S FRANKLIN AVE APT 36
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6120
Country	:	US
Telephone Number	:	516-825-8122
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 S FRANKLIN AVE APT 36
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6120
Country	:	US
Telephone Number	:	516-825-8122
Fax Number	:

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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