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NPI Code Detail

MEDICARE: JESSICA LEE

MEDICARE: JESSICA 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1871950014
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEE
Provider Business Mailing Address
First Line : 2563 COUNTRY VILLAGE CT
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-6514
Country : US
Telephone Number : 734-883-0981
Fax Number :
Provider Business Practice Location Address
First Line : 13725 STARR COMMONWEALTH RD
Second Line :
City : ALBION
State : MI
Zip : 49224-9525
Country : US
Telephone Number : 517-630-2580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2016
Last Update Date : 01/19/2016

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