Provider Demographics
NPI:1538406376
Name:LEE, TODD LORIN
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:LORIN
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 N CANYON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5911
Mailing Address - Country:US
Mailing Address - Phone:801-373-1108
Mailing Address - Fax:
Practice Address - Street 1:5089 S 1500 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3969
Practice Address - Country:US
Practice Address - Phone:801-866-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5176652-4602237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist