Provider Demographics
NPI:1518579747
Name:LEE, KATHRINE (MT-BC)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45026
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5026
Mailing Address - Country:US
Mailing Address - Phone:208-918-2854
Mailing Address - Fax:
Practice Address - Street 1:6654 W MORRIS HILL LN APT 104
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9278
Practice Address - Country:US
Practice Address - Phone:208-918-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13096225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist