Provider Demographics
NPI:1104613488
Name:LEE, JEEWON JENNY
Entity type:Individual
Prefix:
First Name:JEEWON
Middle Name:JENNY
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 W ZOE ELLA WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2930
Mailing Address - Country:US
Mailing Address - Phone:909-670-5914
Mailing Address - Fax:
Practice Address - Street 1:13985 W GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3626
Practice Address - Country:US
Practice Address - Phone:623-251-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA4741231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist