Provider Demographics
NPI:1447337191
Name:LEE, JESSICA CAROLINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CAROLINE
Last Name:LEE
Suffix:
Gender:F
Credentials:MS CCC-SLP
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 255
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:AR
Mailing Address - Zip Code:72028-0255
Mailing Address - Country:US
Mailing Address - Phone:501-745-6606
Mailing Address - Fax:
Practice Address - Street 1:1160 WALKER STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist