Provider Demographics
NPI:1902465164
Name:LEE, SEOYOUNG (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SEOYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 COLLEGE AVE NE APT 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3420
Mailing Address - Country:US
Mailing Address - Phone:616-264-4110
Mailing Address - Fax:
Practice Address - Street 1:357 PIERCY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1403
Practice Address - Country:US
Practice Address - Phone:408-692-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist