Provider Demographics
NPI:1871729145
Name:LEE, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 FRANCE AVE S
Mailing Address - Street 2:SUITE 27
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2008
Mailing Address - Country:US
Mailing Address - Phone:952-303-6023
Mailing Address - Fax:952-928-9362
Practice Address - Street 1:6950 FRANCE AVE S
Practice Address - Street 2:SUITE 27
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2008
Practice Address - Country:US
Practice Address - Phone:952-303-6023
Practice Address - Fax:952-928-9362
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2514237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45-00941OtherMEDICA