MEDICARE: JO ANN K 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	103TC0700X	Clinical Psychologist	PY1508	FL

General Provider Information

NPI Number	:	1649809823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANN K LEE

Provider Business Mailing Address
First Line	:	1502 15TH LN
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-4359
Country	:	US
Telephone Number	:	954-249-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 15TH LN
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-4359
Country	:	US
Telephone Number	:	954-249-7743
Fax Number	:

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

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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