Provider Demographics
NPI:1528284759
Name:LEE, JUNGHAE (CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JUNGHAE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3807
Mailing Address - Country:US
Mailing Address - Phone:928-317-0429
Mailing Address - Fax:928-317-0447
Practice Address - Street 1:1047 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3807
Practice Address - Country:US
Practice Address - Phone:928-317-0429
Practice Address - Fax:928-317-0447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAUD4724231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist