MEDICARE: KRISTY ANN 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	SLP 5078	AZ
2	235Z00000X	Speech-Language Pathologist	SP 18956	CA

General Provider Information

NPI Number	:	1619262771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY ANN LEE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1732 HERRIN ST
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2828
Country	:	US
Telephone Number	:	602-538-1361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 HERRIN ST
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2828
Country	:	US
Telephone Number	:	602-538-1361
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	12/01/2021

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Directions to “ KRISTY ANN LEE MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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